Patient characteristics, fracture distribution and management patterns of incomplete thoracolumbar burst fractures: Results from a retrospective multicenter cohort of 982 patients.
9 affiliations
- 1BG Klinik Ludwigshafen, Department for Orthopaedics and Trauma Surgery at Heidelberg University, Ludwig-Guttmann-Str. 13, Ludwigshafen, 67071, Germany.
- 2Center for Spinal Surgery and Spinal Cord Injury, BG Kliniken Ludwigshafen und Tübingen gGmbH, BG Klinik Tübingen, Tübingen, 72076, Germany.
- 3BG Klinikum Duisburg gGmbH, Duisburg, 47249, Germany.
- 4Center for Spinal Surgery, BG Klinikum Murnau gGmbH, Murnau am Staffelsee, 82418, Germany.
- 5BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, 12683, Germany.
- 6Center for Spinal Surgery and Neurosurgery, BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt am Main, 60389, Germany.
- 7Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bochum, 44789, Germany.
- 8Spine Center, BG Klinikum Hamburg gGmbH, Hamburg, 21033, Germany.
- 9BG Klinikum Bergmannstrost Halle gGmbH, 06112 Halle, Germany and University Medicine Halle, Halle, 06120, Germany.
Abstract
Introduction
Management of neurologically intact AO Spine A3 fractures remains variable, and multicenter data on treatment patterns and conversion to surgery are limited.Research question
Which patient-, injury-, and center-related factors are associated with initial operative treatment and secondary conversion after initial non-operative management?Material and methods
This retrospective multicenter study included adults with neurologically intact A3 fractures from T11 to L2 treated at nine German Level 1 trauma centers between 2018 and 2022. Mixed-effects logistic regression with center as a random intercept evaluated factors associated with initial operative treatment and secondary conversion.Results
Among 982 patients with 1007 fractures, 486 (49.5%) were initially managed non-operatively and 496 (50.5%) operatively. Age group was associated with initial operative treatment (global P < .001), whereas sex, fracture level, additional spinal injury, adjacent fracture, and mobility-restricting injury were not. Initial operative treatment ranged from 37.8% to 65.0% across centers. Secondary conversion occurred in 66 of 486 initially non-operatively managed patients (13.6%; 95% confidence interval 10.7-17.0%); 58 were clinically documented and 8 were identified solely by timing. None of the examined characteristics was independently associated with conversion. Between-center variation was greater for conversion (intraclass correlation coefficient 0.16; median odds ratio 2.13) than for initial operative treatment (intraclass correlation coefficient 0.05; median odds ratio 1.49).Conclusion
Initial operative and non-operative strategies were used equally often, although treatment patterns varied across centers. Age was associated with initial treatment allocation, but measured patient- and injury-related characteristics did not explain the 13.6% secondary conversion rate after initial non-operative management.
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BibTeX
@article{mandelka2026patient,
title = {{Patient characteristics, fracture distribution and management patterns of incomplete thoracolumbar burst fractures: Results from a retrospective multicenter cohort of 982 patients.}},
author = {Eric Mandelka and Mikel Schmelzle Elorriaga and Andreas Badke and Sandra Buchmann and Stefan Hauck and Peter Heumann and Frank Kandziora and Christiane Kruppa and Sebastian Krüger and Bernhard W Ullrich and Sven Y Vetter},
journal = {Brain \& spine},
year = {2026},
month = oct,
doi = {10.1016/j.bas.2026.107472},
url = {https://europepmc.org/article/MED/42921397},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Patient characteristics, fracture distribution and management patterns of incomplete thoracolumbar burst fractures: Results from a retrospective multicenter cohort of 982 patients.
AU - Eric Mandelka
AU - Mikel Schmelzle Elorriaga
AU - Andreas Badke
AU - Sandra Buchmann
AU - Stefan Hauck
AU - Peter Heumann
AU - Frank Kandziora
AU - Christiane Kruppa
AU - Sebastian Krüger
AU - Bernhard W Ullrich
AU - Sven Y Vetter
PY - 2026
DA - 2026/10/13
JO - Brain & spine
DO - 10.1016/j.bas.2026.107472
UR - https://europepmc.org/article/MED/42921397
AB - Introduction Management of neurologically intact AO Spine A3 fractures remains variable, and multicenter data on treatment patterns and conversion to surgery are limited.Research question Which patient-, injury-, and center-related factors are associated with initial operative treatment and secondary conversion after initial non-operative management?Material and methods This retrospective multicenter study included adults with neurologically intact A3 fractures from T11 to L2 treated at nine German Level 1 trauma centers between 2018 and 2022. Mixed-effects logistic regression with center as a random intercept evaluated factors associated with initial operative treatment and secondary conversion.Results Among 982 patients with 1007 fractures, 486 (49.5%) were initially managed non-operatively and 496 (50.5%) operatively. Age group was associated with initial operative treatment (global P < .001), whereas sex, fracture level, additional spinal injury, adjacent fracture, and mobility-restricting injury were not. Initial operative treatment ranged from 37.8% to 65.0% across centers. Secondary conversion occurred in 66 of 486 initially non-operatively managed patients (13.6%; 95% confidence interval 10.7-17.0%); 58 were clinically documented and 8 were identified solely by timing. None of the examined characteristics was independently associated with conversion. Between-center variation was greater for conversion (intraclass correlation coefficient 0.16; median odds ratio 2.13) than for initial operative treatment (intraclass correlation coefficient 0.05; median odds ratio 1.49).Conclusion Initial operative and non-operative strategies were used equally often, although treatment patterns varied across centers. Age was associated with initial treatment allocation, but measured patient- and injury-related characteristics did not explain the 13.6% secondary conversion rate after initial non-operative management.
SN - 2772-5294
ER -