Return-to-Work Outcomes Following Surgical vs Conservative Treatment of Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis.

Authors

Mohamed M Aly, Ibrahim Serag, Faisal Konbaz, Mohammad M Alshardan, Abdulwahed Barnawi, Mohannad W Awwad, Bassam M J Addas, Ahmed Alzahrani

Published in

International journal of spine surgery. Jul 31, 2026. Epub Jul 31, 2026.

Abstract

The optimal management of neurologically intact thoracolumbar burst fractures remains controversial. Although surgical treatment may provide earlier stabilization and deformity correction, nonsurgical management avoids surgical morbidity and health care costs. Return to work (RTW) is a clinically meaningful outcome that reflects both functional recovery and socioeconomic reintegration. We aimed to compare RTW outcomes following surgical vs nonsurgical treatment of neurologically intact thoracolumbar burst fractures.
We systematically searched PubMed, Scopus, and Web of Science from inception to March 2026 for comparative studies evaluating RTW outcomes after surgical and nonsurgical treatment of adult patients with AO Spine A3/A4 thoracolumbar burst fractures without neurological deficits. Primary outcomes included time to RTW, overall RTW rate, and return to the same or modified work. Secondary outcomes included pain, disability, and quality of life (QoL). Random-effects meta-analyses were performed.
Ten studies involving 632 patients (324 surgical and 308 nonsurgical) were included, of which 8 were eligible for meta-analysis. Surgical treatment was associated with a significantly shorter time to RTW (mean difference [MD] -104.11 days; 95% CI -178.14 to -30.08; P = 0.006), although heterogeneity was substantial (I² = 96%). No significant difference was observed in the overall RTW rate between treatment groups (OR 0.62; 95% CI 0.25-1.56; P = 0.31). Subgroup analysis demonstrated a lower odds of RTW in the surgical group at 6 months (OR 0.22; 95% CI 0.07-0.70; P = 0.01), whereas no difference was observed at final follow-up. Similarly, there were no significant differences in return to the same work (OR 1.04; P = 0.98) or modified work (OR 1.47; P = 0.56). Pain (MD 0.03; P = 0.93), disability (MD 1.28; P = 0.80), and QoL (MD 2.79; P = 0.46) were comparable between groups.
Among neurologically intact patients with thoracolumbar burst fractures, surgical treatment may facilitate an earlier RTW; however, it does not improve long-term work participation, occupational reintegration, pain, disability, or QoL compared with nonsurgical management. Given the comparable long-term functional outcomes, treatment decisions should be individualized and guided by fracture characteristics, patient preferences, and shared decision-making rather than expectations of superior long-term recovery with surgery alone.
Surgical treatment may facilitate earlier return to work in neurologically intact thoracolumbar burst fractures but does not improve long-term work participation, pain, disability, or quality of life. Treatment decisions should therefore be individualized based on fracture characteristics, patient priorities, and shared decision-making.

PMID:
42538135
Bibliographic data and abstract were imported from PubMed on 01 Aug 2026.

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