Long-term Outcomes of Hyperextension Casting vs Short-segment Instrumentation in TLICS 4 Thoracolumbar Fractures

This study aimed to compare long-term clinical and radiological outcomes of conservative treatment using hyperextension casting versus surgical treatment (short-segment instrumentation) for thoracolumbar vertebral fractures classified as Thoracolumbar Injury Classification and Severity Score (TLICS) score 4. Methods. Patients diagnosed with stable compression fractures at T10–L2 who underwent conservative hyperextension casting (Group A, n=28) or surgical short-segment instrumentation (Group B, n=36) between 2004 and 2014 were retrospectively reviewed. Pain levels (Visual Analogue Scale), functional outcomes (Oswestry Disability Index), local kyphosis angle (Cobb Angle), anterior vertebral body height compression (ACVBH), and patient satisfaction were evaluated. Results. There were no significant differences between groups regarding age, gender, BMD, or follow-up duration. Hospital stay was significantly longer in Group B (5.1±2.5 vs. 2.1±0.7 days; p<0.001, Cohen’s d=1.55). Radiological parameters (Cobb angle, ACVBH, SI) showed no significant differences at final follow-up. However, Group B demonstrated significantly superior outcomes in Oswestry Disability Index (ODI) at follow-up (p<0.001, Cohen’s d=1.23) and Visual Analogue Scale (VAS) scores at pre-treatment (p=0.047, Cohen’s d=0.53), post-treatment (p=0.024, Cohen’s d=0.57), and follow-up (p<0.001, Cohen’s d=1.18). Complication rates were comparable between groups. Conclusion. Hyperextension casting provided similar radiological outcomes to surgical treatment, although surgical intervention offered better functional outcomes and pain relief. Treatment choice should consider individual patient factors and fracture characteristics. Keywords: Thoracolumbar fracture, hyperextension cast, short-segment instrumentation, kyphosis angle, functional outcome.