Surgical versus Non-Surgical Treatment of Thoracolumbar Burst Fractures in Neurologically Intact Patients: A Prospective International Multicentre Cohort Study
Bibliographic record
Abstract
Study design Prospective cohort study. Objectives Treatment for thoracolumbar (TL) burst fractures in neurologically intact patients remains controversial. The goal of this study was to utilize the international equipoise to determine whether surgery leads to a more rapid improvement of disability measured by minimal clinically important difference (MCID) in Oswestry Disability Index (ODI). Methods The primary endpoint was time to achieve an improvement in ODI of more than 12.8 points within 1 year after baseline (MCID). A post hoc analysis was conducted to assess time to minimal disability (ODI of <20). Time-to-event analyses were applied, including log rank test for equality of survivor functions, Kaplan Meier survival curves and Cox proportional hazard models. Results One hundred and ninety-eight patients were included (122 surgical and 76 non-surgical patients). Median time to achieve MCID in ODI (12.8 points) from baseline was similar between the two groups (25.0 days vs 25.5 days, P = 0.517). Post hoc analysis showed a potential trend towards a short time to achieve minimal disability for the surgical group (69.0 days vs 82.0 days, P = 0.057). Similar results were obtained when excluding all patients with suspected PLC injury. Conclusion Surgically and non-surgically treated patients with thoracolumbar burst fractures without neurological injury were similar in terms of time to reaching MCID in ODI at 1 year. Surgical patients may reach minimal disability faster than nonsurgical patients, but additional large scale studies are warranted. Level of Evidence Therapeutic Prospective Comparative Cohort Study Level II.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".