The economic implications of operative vs. non-operative management of thoracolumbar burst fractures: A systematic review

Thoracolumbar burst fractures are a common injury that accounts for nearly one-sixth of all thoracolumbar injuries. Management options for thoracolumbar burst fractures consist of operative or non-operative approaches, both of which have been demonstrated to be successful. However, the economic implications of different management options are poorly characterized. This article is a systematic review of the existing literature and outlines the current knowledge on comparative cost-effectiveness of operative vs. non-operative management of thoracolumbar burst fractures. Out of 259 identified articles, 32 underwent full text review and only 5 addressed economic issues that allowed for a comparison of the cost-effectiveness of operative vs. non-operative approaches. The findings suggest that there is a limited understanding of the cost-effectiveness of either approach and, in particular, a lack of American studies into this issue. Guidance is needed for decision making in regards to the most cost-effective management of thoracolumbar burst fractures. We suggest that a randomized prospective cost-effectiveness trial of thoracolumbar burst fractures treated operatively or non-operatively would be valuable in guiding efficient management of these injuries.