Evaluation of Functional Outcomes and Return to Work in Thoracolumbar Junction Fractures (T11–L2) Following Posterior Spinal Fusion: A Prospective Observational Study Publisher



Shokouhi G ; Sohrabiasl M ; Bavil M ; Meshkini A ; Iranmehr A ; Rezapoor E
Source: European Spine Journal Published:2025

Abstract

Purpose: Fractures at the thoracolumbar junction (T11–L2) represent a critical spinal trauma pattern due to biomechanical transition zones. Treatment decisions, especially between conservative and surgical approaches like posterior spinal fusion (PSF), remain debated. This study evaluates the functional, neurological, and occupational outcomes of patients treated with or without PSF. Methods: A prospective cohort of 80 patients with thoracolumbar junction fractures was followed for 9 months at a tertiary trauma referral center. Fifty-five patients received PSF, and 25 underwent non-surgical management. Outcomes assessed included kyphosis correction (Cobb’s angle), American Spinal Injury Association (ASIA) motor score, Oswestry Disability Index (ODI), and return-to-work (RTW) proportion. Statistical methods included Wilcoxon signed-rank tests, chi-square tests, and multivariate logistic regression. Results: Surgically treated patients showed significant kyphotic correction (mean change: +1.93°, p = 0.0013) and greater neurological improvement (mean ASIA gain: +6.91 vs. +2.00, p < 0.001). Surprisingly, ODI scores worsened in surgical patients (+ 3.89, p < 0.001) and showed no significant change in the non-surgical group. RTW was significantly higher in the surgical group at 6 and 9 months (75% vs. 32% and 93% vs. 64%, respectively). Multivariate analysis identified surgery as the only independent predictor of RTW at 9 months (OR = 8.96, p = 0.021). Conclusion: Posterior spinal fusion was associated with improved kyphosis correction, neurological recovery, and return-to-work at 9 months. However, disability scores did not improve and in some cases worsened, highlighting the importance of patient selection and postoperative rehabilitation. © 2025 Elsevier B.V., All rights reserved.