Comments on “Management of traumatic thoracolumbar fractures ...”

Good question; however, no new question—for over 20 years there have been attempts to find out about limitations, the advantages and/or indications for conservative or operative treatment for thoracolumbar injuries.

The method of the presented paper was obviously not appropriate: 10 years of publications for this specific question is unacceptable. There are more papers available [1, 2, 5–7, 9, 18, 22]. Why not include publications dealing with either conservative or operative treatment only? For the given question a review including the information of these publications would be helpful. More detailed information on the advantages and the results after conservative and operative treatment is already available. There are papers, comparing results after different methods of operative treatment [10–12], as well as long-term results after conservative treatment [4, 8, 13–17, 19–21, 23], to mention only a few. An overview of treatment modalities and their expectable results are presented [3].

One could not expect an answer for the posed question with the presented method. As a consequence no relevant results were found and presented in the paper. A key point might be the classification. Maybe we have to address the question of instability in more detail: the frequently used terms “unstable lesion” and “burst fracture” are perhaps inappropriate to serve as a base for decision making! Today, we have the feeling that we might have to draw the line between non-operative and operative treatment somewhere within these terms.

Finding these 17 papers and realising that there is no additional information compared with what is already known and presented in review articles, one should not try to write another meta-analysis without value, but should initiate a study as proposed in the conclusions!