Long–term outcomes in physical function and quality of life after traumatic thoracolumbar A3/A4 fractures: a comparison of conservative versus surgical management

To provide insight into the recovery rates of patient-reported outcome measures (PROMs) in terms of physical functioning and health-related quality of life (QoL) in patients with an A3/A4 thoracolumbar vertebral fracture, compared to the general population. Additionally, differences in outcomes between conservatively and surgically treated patients were assessed. A retrospective cohort study with cross-sectional follow-up including patients with thoracolumbar A3/A4 vertebral fractures in a level 1 trauma center between 2010 and 2020. SMFA-NL was used to evaluate physical functioning, and EQ-5D was used to assess QoL. Outcomes were compared with normative data from the Dutch population. Patient-reported outcomes and complication rates were reported for each treatment type. Recovery was defined as reaching the lower limit of the 95% confidence interval of the normative data in all outcome measures. PROMs were available for 98 (37%) of the eligible patients with a median follow-up of 4.5 (IQR = 5.6) years. No significant differences in physical functioning or QoL were found between conservatively and surgically treated patients. The following non-recovery rates were found in the conservatively treated patients: physical functioning = 56–74%, QoL = 48% and in the surgically treated patients: physical functioning = 77–80%, QoL = 45%. Surgically treated patients showed significantly higher complication rates than conservatively treated patients. Thoracolumbar A3 and A4 fractures are associated with long-term reduced physical functioning and quality of life compared with the general population, regardless of treatment strategy. Both surgically and conservatively treated patients showed significantly low recovery rates in comparison with their peers from the general population.