Radiologic factors in thoracolumbar burst fractures with versus without neurologic deficit: a systematic review and meta-analysis.

STUDY

DESIGN

Systematic review and meta-analysis.

OBJECTIVES

This study aimed to compare radiologic parameters reflecting structural canal morphology and vertebral body collapse (canal compromise by mid-sagittal diameter and cross-sectional area, and vertebral height loss) in thoracolumbar burst fractures with versus without neurological deficit (ND).

METHODS

A systematic search was conducted across MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane CENTRAL up to October 31, 2025. Studies reporting canal compression, vertebral height loss, and interpedicular distance, measured as percentages relative to adjacent uninjured vertebrae in patients with thoracolumbar (T10-L2) burst fractures, were included. Results were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs).

RESULTS

Of 9918 articles identified, eight studies were included (336 patients: 159 with, 177 without ND). The percentage of canal cross-sectional area compression was significantly higher in fractures with ND (SMD: 14.31, 95% CI: 9.03 to 19.59, P < 0.001). Canal mid-sagittal diameter compression (SMD: 9.37, 95% CI: -1.61 to 20.36, P = 0.09) did not differ significantly between groups. Vertebral height loss data could not be pooled due to variations in imaging modality and patient positioning; descriptively, the data did not show a consistent pattern between two groups. No study reported the interpedicular distance in patients with and without ND.

CONCLUSIONS

We found that canal cross-sectional area is the most consistent radiologic parameter associated with ND in thoracolumbar burst fractures. Mid-sagittal diameter compromise did not show a reliable difference in our analysis; vertebral height loss could not be analysed because of methodological heterogeneity.