Comparison of Conservative Therapy and Surgical Treatment Outcomes in Patients  with Uncomplicated AOSpine Type A3 Fractures at the Thoracolumbar Junction

A. A. Grin; A. E. Talypov; A. Yu. Kordonskiy; V. A. Karanadze; I. S. Lvov; R. I. Abdrafiev; I. V. Pogonchenkova; E. V. Kostenko; M. R. Makarova; A. V. Leonov

doi:10.14531/ss2026.2.37-47

Comparison of Conservative Therapy and Surgical Treatment Outcomes in Patients with Uncomplicated AOSpine Type A3 Fractures at the Thoracolumbar Junction

https://doi.org/10.14531/ss2026.2.37-47

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Abstract

Objective. To perform comparative analysis of long-term clinical and radiological results of conservative therapy and surgical treatment of patients with uncomplicated fractures of the AOSpine type A3 vertebrae in the thoracolumbar junction.

Material and Methods. The research is a prospective comparative non-inferiority study with historical control. The inclusion criteria were patient age over 18 years, acute or subacute injury, uncomplicated AOSpine type A3 fracture at the T10–L2 level, and spinal canal stenosis of less than 50%. The conservative therapy group (CoT) received fracture immobilization with a rigid frame brace, followed by a two-phase rehabilitation course starting on the first or second day after diagnosis. The surgical treatment group (ST; n = 23) included patients who underwent anterior fusion or transpedicular fixation without decompression. The CoT group was followed for 12 months. The primary endpoint was the quality of life according to the Oswestry scale (ODI), secondary endpoints were the level of pain according to the VAS, the dynamics of the Cobb angle, spinal stenosis, as well as degenerative changes in the facet joints and intervertebral discs.

Results. Patients in the CoT group were on average 10 years older than those in the ST group upon admission (p = 0.049); other demographic and radiographic parameters did not differ significantly between the groups. At the follow-up, the median VAS pain scores in the CoT and ST groups were 0 and 2 points, (p < 0.001) and the ODI value was 4 and 12 (p < 0.001), respectively. The ST group demonstrated a smaller increase in the Cobb angle compared to the CoT group (0.7° and 4.9°, respectively) due to surgical correction of kyphosis and its maintenance using metal implants, as well as a twofold greater restoration of the spinal canal lumen (t-test; p = 0.007). However, the final spinal stenosis indices did not differ significantly between the groups. Ankylosis of the facet joints and intervertebral discs, both at the level of injury and in adjacent segments, was significantly more frequent after surgical treatment (χ² test; p < 0.001 and p = 0.001, respectively). Fracture union as a result of treatment was detected in 91.3% of patients in the ST group and in 88.2% in the CoT group (χ² test; p = 0.193).

Conclusion. Long-term treatment outcomes of uncomplicated AOSpine type A3 fractures at the thoracolumbar junction demonstrate that conservative therapy is comparable to surgical treatment for kyphotic deformity less than 14.9°, relative anterior vertebral body height greater than 51.8%, vertebral body index greater than 0.54, and spinal stenosis less than 43.9%. Rehabilitation should begin within 24 hours of diagnosis and continue in a rehabilitation center. Surgical treatment allows for better correction of kyphotic deformity and spinal canal stenosis, but it also promotes degenerative changes both in the fractured vertebra and in adjacent segments. The final decision regarding the choice of treatment method (surgical or conservative) should be made in consultation with the patient, taking into account the comparable clinical outcome, the need for deformity correction and the likelihood of complications.