Long-term Differences In Physical Functioning And Quality Of Life Between Conservatively And Surgically Treated Traumatic Thoracolumbar A3/A4 Fractures

Purpose To compare recovery rates of patient-reported outcome measures (PROMs) in terms of physical functioning and health-related quality of life (QoL) between surgically treated and conservatively treated patients with an A3/A4 thoracolumbar vertebral fracture, and compared to the general population. Methods A cross-sectional study 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. Results 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. Conclusion No significant differences were found between conservatively and surgically treated patients with a thoracolumbar A3/A4 fracture in outcome regarding physical functioning or QoL. However, both surgically and conservatively treated patients showed significantly low recovery rates, up to 80% of no recovery, in comparison with their peers from the general population.