Delayed Surgical Management of Symptomatic Old Thoracolumbar Fractures: A Systematic Review of Clinical Outcomes

Introduction: Symptomatic old thoracolumbar fractures often present with persistent pain, neurological deficits, and reduced quality of life. Delayed surgical management offers potential benefits but remains controversial due to concerns about efficacy and risks. This systematic review assesses clinical outcomes associated with delayed surgery for symptomatic thoracolumbar fractures, focusing on pain relief, neurological improvement, and functional recovery.

Methods: Following PRISMA guidelines, a systematic review was performed on studies published from 2010 to 2023, examining delayed surgical interventions for symptomatic old thoracolumbar fractures. Inclusion criteria targeted studies with postoperative evaluations of pain (Visual Analogue Scale, VAS), neurological function (American Spinal Injury Association, ASIA scores), and functional capacity (Oswestry Disability Index, ODI). Meta-analysis using R and Python focused on changes in VAS, ASIA, and ODI scores, and evaluated risk ratios for complication rates.

Results: Data from nine studies, encompassing 420 patients, indicated significant post-surgical improvements. Mean VAS scores decreased by 40% (p < 0.01), with reductions in chronic pain symptoms. Neurological function improved in 60% of patients, particularly those initially classified as ASIA B or C, with 20% achieving ASIA D or E at final follow-up. ODI scores showed a mean improvement of 30% in functional capacity. Complication rates were moderate, with infection and implant-related issues occurring in 5% of cases, though outcomes were unaffected long-term.

Conclusion : Delayed surgical intervention for symptomatic old thoracolumbar fractures is associated with substantial pain relief, neurological recovery, and functional improvements, providing a viable option for patients suffering chronic effects of untreated fractures. Although complications were present, they were generally manageable and did not impact long-term recovery. These findings support delayed surgery as an effective intervention, particularly for patients with debilitating symptoms and no improvement from conservative treatment. Further studies with larger cohorts are recommended to strengthen guidelines on timing and selection criteria.