Outcomes of Treatment of Thoracolumbar Burst Fractures with Intact Neurology Treated in Karnali Academy of Health Sciences, Nepal.

Background The vulnerability of the thoracolumbar junction for a higher incidence of fracture with neural injury is mainly due to its anatomical peculiarity. The management of thoracolumbar burst fractures remains controversial due to the potential for further neurological deterioration and vertebral collapse at the thoracolumbar junction. Objective To investigate the outcomes of treatment of thoracolumbar burst fractures with intact neurology treated in Karnali Academy of Health Sciences, Nepal. Method This retrospective comparative study was done at Karnali Academy of Health Sciences, which included patients with thoracolumbar burst fractures classified as AO type A3 and A4, treated conservatively or operatively at 2 years follow-up. Data on demographics, kyphotic angles at injury were collected and at 2 years follow-up, and Patient-Reported Outcomes with the Nepali version (PROST) and Visual Analog Scale (VAS) scores for pain assessment. Result The results showed that 32 patients had a mean age of 43.47 years, with a majority in the 30-49 age group, showed a female predominance (56.3%) and fall injuries as the most common cause (78.2%). A total of 18 cases of AO type A3 and A4 were managed conservatively, while 14 cases were managed operatively of AO type A4. There was a significant difference in the kyphotic angle correction in operative cases (19.57 ± 8.19 vs 13.21 ± 5.57 degree (p-value < 0.001). In addition, there was no statistically significant improvement in functional outcome via PROST scores (p-value = 0.718) and VAS score (p-value = 0.450) in conservative and operative treatment. Conclusion Surgical intervention significantly improved kyphotic angles in AO type A4 patients, but the conservative management in both AO type A3 and AO A4 showed no significant change in kyphotic angle. However, PROST Nepali score and VAS score among conservative and operative cases were comparable and not statistically significant.