Subaxial spine trauma: radiological approach and practical implications.

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Abstract

[Indexed for MEDLINE] 3. World Neurosurg. 2026 Apr 20:124995. doi: 10.1016/j.wneu.2026.124995. Online ahead of print. Operative versus conservative management of AO Spine A3 and A4 thoracolumbar burst fractures: a systematic review of outcomes, risk factors, and anatomical level. Weber M(1), Hockmann J(2), Babasiz T(2), Eysel P(2), Müller LP(2), Wegmann S(2). Author information: (1)Department for Orthopaedic and Trauma surgery, Medical Faculty, University of Cologne, 50931 Cologne, Germany. Electronic address: maximilian.weber1@uk-koeln.de. (2)Department for Orthopaedic and Trauma surgery, Medical Faculty, University of Cologne, 50931 Cologne, Germany. BACKGROUND: Thoracolumbar fractures represent a common clinical problem, yet the decision between operative and non-operative treatment remains controversial. Despite the availability of established classifications, patient-specific factors and long-term outcomes are often underrepresented in treatment algorithms. OBJECTIVE: This study aimed to compare operative and non-operative management of thoracolumbar fractures with a focus on clinical outcomes, complications, and long-term implications. METHODS: We conducted a structured review of the current literature, including randomized and observational studies with follow-up ranging from short-term (2-5 years) to more extended observations. Clinical outcome measures, complication rates, and radiographic findings were extracted and synthesized. RESULTS: Evidence indicates that both treatment strategies can achieve acceptable short-term outcomes in selected patients. Operative management is frequently chosen in polytrauma settings due to the advantages of early mobilization and intensive care unit management. However, most available studies are limited by relatively short follow-up, with only isolated reports exceeding 20 years. Consequently, late sequelae such as adjacent segment degeneration and chronic pain may be underestimated. CONCLUSIONS: Operative and non-operative treatments for thoracolumbar fractures both have merits, but current evidence is constrained by limited long-term data. Future research should prioritize extended follow-up and integrate patient-specific factors into decision-making frameworks to better inform individualized treatment strategies. Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.wneu.2026.124995