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Patients treated with surgery return to work earlier.
2%
108/4567
Patients treated with surgery have decreased pain scores.
1%
44/4567
Patients treated with surgery have increased complication rates.
79%
3588/4567
Patients treated with surgery have improved final SF-36 scores.
49/4567
All of the above
17%
757/4567
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The clinical presentation is consistent for a stable thoracolumbar burst fracture with no neurological deficits. New studies have shown operative treatment of patients with a stable thoracolumbar burst fracture and normal findings on the neurological examination provided no major long-term advantage compared with nonoperative treatment, but does have an increased complication rate. The thoracolumbar injury classification and severity score (TLICS) was developed to address deficits in reliability and prognostic accuracy of historical classification systems. TLICS is based on three characteristics: (1) injury morphology, (2) integrity of the posterior ligamentous complex and (3) patient neurologic status. TLICS allows determination of which injuries are stable and its reliability has been validated. Wood et al performed a prospective, randomized trial in which the authors found: 1) no significant difference between the two groups with respect to return to work. 2) The average pain scores at the time of the latest follow-up were similar for both groups. 3) At the time of the final follow-up, those who were treated nonoperatively reported less disability. 4) Final scores on the SF-36 and Oswestry questionnaires were similar for the two groups. 5) Complications were more frequent in the operative group. Mumford et al looked at the clinical outcome and efficacy of closed management of thoracolumbar burst fractures in patients with no neurological deficits. They found nonoperative management as the preferred treatment in these circumstances. Illustration A shows the point system used in the TLICS classification scheme. Patients scoring less than 4 are managed without surgery. Patients scoring more than 4 are managed operatively. Patients with a score of 4 can be managed either operatively or nonoperatively. Incorrect answers: Answers 1, 2, 4, 5: Surgery does not add benefit in stable thoracolumbar burst fractures without neurologic deficit.
3.6
(28)
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