Gender Differences in Outcomes in Patients Treated for Thoracolumbar Burst Fractures Without Neurological Deficits: Prospective International Multicenter Study
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Exploring gender differences in outcomes after spinal surgery is essential. We aimed to assess gender differences in patients treated for thoracolumbar burst fractures without neurological deficit regarding Oswestry Disability Index (ODI) improvement. Secondarily, we assessed baseline characteristics, treatment selection, and other patient-reported outcomes. METHODS: Data were prospectively collected. The primary end point was defined as time to achieve minimal clinically important difference (MCID) in ODI. In an exploratory analysis, we defined improvement in ODI as reaching minimal disability. RESULTS: Genders had similar baseline characteristics, injury characteristics, and treatment selection and timing.Surgically treated women showed a faster achievement of MCID in ODI (14 days, 95% CI 14.0-28.0 vs 28 days, 95% CI 15.0-34.0, P = .009). On multivariable modeling, nonoperatively treated women had a lower chance of achieving improvement in the ODI than nonoperatively treated men (hazard ratio 0.55, 95% CI: 0.32-0.96, P = .036).Women had a longer median time to achieve minimal disability (102.0 days, 95% CI: 76.0; 131.0 vs 62.0 days, 95% CI: 51.0; 72.0, P = .008). Nonoperative women had a longer median time to achieve minimal disability (130.0 days, 95% CI: 82.0-185.0 vs 61.0 days, 95% CI: 47.0-76.0, P = .048). On multivariable modeling, nonoperative women had a lower chance for achieving minimal disability than nonoperatively treated men (hazard ratio 0.55, 95% CI 0.31-0.98 P = .042). CONCLUSION: This novel study reports gender differences in thoracolumbar burst fractures in neurologically intact patient. Women do worse with nonoperative management than men. In addition, women do better with operative than nonoperative management in achieving MCID, whereas this was not observed in men. Thus, women benefit to a greater extent from surgical management than do men. These results highlight the importance of personalized treatment that incorporates gender. Future studies should assess gender differences in other traumatic spinal pathologies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".