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Spinal Canal Decompression and Neurological Outcome in Thoracolumbar Burst Fractures; A Review of Evidence- Based Data

Background The association between neurologic recovery and initial compromise of spinal canal has not been frequently documented and the controversy persists regarding the management of bone fragments within the spinal canal after thoracolumbar burst fractures. Although, the surgical clearance of the spinal canal, either by direct removal of bone fragments or by ligamentotaxis, is generally accepted as the treatment of choice for burst fractures, debate persists as to whether surgical decompression is necessary to treat burst fractures. Objective To better understand whether the degree of neurologic recovery from thoracolumbar burst fractures is affected and predicted by initial compromise of spinal canal and to which extent the decompression is helpful, via reviewing the evidence-based data of the literature. Methods Up-to-date, the experimental and clinical literature concerning the role of, and the biological rationale for, surgical decompression after acute Spinal Cord Injury (SCI) were reviewed. Evidence from clinical trials was categorized as Class I (well-conducted randomized prospective trials), Class II (well-designed comparative clinical studies), or Class III (retrospective studies). Conclusion Although, there is a biological evidence from experimental studies in animals that decompressive surgery may improve neurological recovery after SCI, the role of surgical decompression in patients with SCI is only supported by Class III and limited Class II evidence. Accordingly, decompressive surgery for thoracolumbar burst fractures can only be considered a practice option.