Fifty-five patients who had sustained a burst fracture of the lumbar spine were followed for a mean of seventy-nine months (range, twenty-four to 192 months) after the injury. Thirty patients had been managed non-operatively with a short period of
bed rest followed by protected mobilization. The remaining twenty-five patients had been managed operatively: eight, with posterior
arthrodesis with long-segment hook-and-rod fixation; eight, with posterior
arthrodesis with short-segment transpedicular fixation; six, with posterior
arthrodesis and instrumentation followed by anterior
decompression and
arthrodesis; and three, with anterior
decompression and
arthrodesis. Thirty-six patients had been neurologically intact at the time of presentation and had remained so throughout the follow-up period. No neurological deterioration or symptoms of late
spinal stenosis were seen. Isolated partial single-nerve-root deficits resolved regardless of the method of treatment. Patients who had had a complete single or a multiple-nerve-root
paralysis seemed to have benefited from anterior
decompression. Although the anatomical results as seen on the most recent radiographs were superior for the group that had been managed operatively with long posterior fixation or anterior and posterior
arthrodesis, the most recent
pain scores and the functional outcomes were similar for all treatment groups. At the latest follow-up evaluation, some loss of spinal alignment was noted in the patients who had been managed with short transpedicular fixation; the alignment at the most recent follow-up examination was comparable with that in the patients who had been managed non-operatively. For the patients who had had non-operative treatment, we were unable to predict the
deformity at the time of follow-up on the basis of the initial diagnostic radiographs. The clinical outcome was not related to the
deformity at the latest follow-up evaluation. On the basis of the results of our study, we recommend non-operative treatment for patients who do not have neurological dysfunction or who have an isolated partial nerve-root deficit at the time of presentation. For patients who have a multiple-nerve-root
paralysis, anterior
decompression is indicated.