***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY DESIGN A retrospective review of 42 patients treated at three major medical centers for burst fractures of L3 , L4 , and L5 . This is the largest low lumbar ( L3-L5 ) burst fracture study in the literature to date . The study was design ed to assess both radiographic and clinical outcomes in a cohort of patients treated during a 16-year period . OBJECTIVES The objective of this study was to determine whether conservatively treated patients with low lumbar burst fractures had satisfactory outcomes compared with those in a surgically treated cohort of patients . The study included patients with and without neurologic deficits . SUMMARY OF BACKGROUND DATA Burst fractures of the low lumbar spine ( L3-L5 ) represent a small percentage of all spine fractures . The iliolumbar ligaments and location below the pelvic brim are two stabilizing factors that are unique to these fractures when compared with burst fractures at the thoracolumbar junction . METHODS Forty-two ( n = 42 ) patients with low lumbar burst fractures were identified from 1980 through 1996 . Medical records , radiographs , and follow-up Dallas Pain Question naires were obtained . Loss of anterior vertebral height , kyphotic angulation , and amount of retropulsion were recorded at several phases of treatment . Mean follow-up time was 45.2 months ( range , 5 - 132 months ) . Twenty patients were treated without surgery ( 18 were neurologically intact , and 2 had isolated nerve root injury ) , and 22 underwent surgery ( 14 had neurologic injury , 8 were intact ) . RESULTS No patient showed neurologic deterioration , regardless of treatment . Fracture of the third lumbar segment showed the greatest tendency toward kyphotic collapse and loss of height in the nonoperative group , although this was not reflected in the final functional outcome of both groups . The ability to return to work and achieve a good-to-excellent long-term result was not significantly different among fracture levels or between surgical and nonsurgical treatments . CONCLUSIONS The results of nonoperative treatment of low lumbar burst fractures were comparable with those of operative treatment . The rate of repeat surgery ( 41 % ) and absence of a clearly definable long-term functional or radiographic benefit in patients without neurologic compromise may make surgery less appealing Study Design . Prospect i ve cohort study . Objectives . To study the predictive value of magnetic resonance imaging ( MRI ) findings of thoracolumbar spine fractures concerning the radiologic and clinical outcome . Summary of Background Data . Disagreement about the proper treatment of thoracolumbar spine fractures is caused by insufficiency of conventional imaging techniques . Previous studies have shown that MRI is capable of distinguishing injury to all structures of the fractured spine and thus may help develop schemes with higher predictive power . Methods . A total of 53 patients with 71 fractures were studied with MRI in a prospect i ve fashion . A total of 24 patients with 39 fractures were treated conservatively and 29 patients with 32 fractures were treated operatively after a protocol concerning the treatment options . MRI scans were obtained within 1 week of injury and at the 2-year follow-up . Pain scores were obtained at the 2-year follow-up . Previously described MRI schemes concerning the trauma and post-trauma conditions were used . Results and Conclusions . An unfavorable outcome in the conservative group was related to the progression of kyphosis , which in most cases was predictable with the use of trauma MRI findings concerning the endplate comminution and vertebral body involvement . In the operatively treated group , recurrence of the kyphotic deformity was predictable by the lesion of the posterior longitudinal ligamentary complex together with endplate comminution and vertebral body involvement as seen on trauma MRI . The authors recommend the use of MRI to develop reliable prognostic criteria for these injuries BACKGROUND Both surgery and recumbency have been adopted in the treatment of spinal fractures . Herein we present the indications for each , and our experience with thoracolumbar junction ( T12 , L1 and L2 ) burst fractures . METHODS Sixty-eight patients with thoracolumbar burst fractures were treated operatively in 36 cases , and nonoperatively in 32 with recumbency  for 1 - 6 weeks . Treatment was based on clinical and radiological criteria . Eighty-one percent of the recumbency patients , but only 14 % of the surgical patients were intact on admission . Patients were followed for a mean+/-SD of 9+/-10 months in the recumbency group , and 21+/-21 months in the surgical group . RESULTS Neurological improvement and progressive angular deformity occurred in both groups . The cost of recumbency in our patients was nearly half that of those who required surgery , though the length of hospitalization between the two groups was similar at 1 month + /-2 weeks . CONCLUSION The above study emphasizes that the selection of operative versus nonoperative treatment in burst fractures should not be r and om but based on clinical as well as radiological criteria . Recumbency is favored in patients who are intact , with angular deformity less than 20 degrees , a residual spinal canal greater than 50 % of normal , and an anterior body height exceeding 50 % of the posterior height . Surgical intervention is generally indicated in patients with partial neurological deficit , and those with severe instability Study Design . A prospect i ve clinical trial was conducted . Objective . To compare the results of nonoperative treatment versus short-segment posterior fixation using pedicle screws . Summary of Background Data . A previous study showed that nonoperative treatment with early mobilization produced good results , even when the posterior column was involved . Methods . This study involved 80 patients . Inclusion criteria required the following : neurologically intact patient , single-level closed burst fracture involving T11–L2 , no fracture dislocations or pedicle fractures , age of 18 to 65 years ( nonpathologic adult ) , and no other major organ system or musculoskeletal injuries . Patients in the nonoperative group ( n = 47 ) were allowed activity to the point of pain tolerance beginning on the day of injury using a hyperextension brace . Patients in the operative group ( n = 33 ) underwent three-level , ( one above , one at fracture level , and one below ) fixation using VSP or TSRH instrumentation . The follow-up period was 2 years . Results . The surgical group had less pain up to 3 months and a better Greenough Low Back Outcome Score up to 6 months , but the outcome was similar afterward . No neurologic deficit in any patient . In the nonoperative group , the kyphosis angle worsened by 4 ° , and the retropulsion decreased from 34 % to 15 % . In the operative group , there was one case of superficial infection and two cases of broken screws . The kyphosis angle was improved initially by 17 ° , but this was gradually lost . Hospital charges were four times higher in the operative group . Conclusions . Short-segment posterior fixation provides partial kyphosis correction and earlier pain relief , but the functional outcome at 2 years is similar . Early activity to the point of pain tolerance can be safely allowed This study consisted of 1,019 spinal fracture patients followed prospect ively for 2 years . Sixty-four physicians from 12 countries participated . The purpose of the study was to determine : 1 ) the relationship between neurologic deficit and fracture type , level , and spinal canal compromise ; 2 ) the neurologic outcome comparing surgical versus nonsurgical treatment and anterior versus posterior surgery ; and 3 ) the relationship of pain to both kyphotic deformity and to surgical and nonsurgical treatment . The main findings of this study are as follows : 1 ) seat belts reduced the incidence of severe neurologic injury ; 2 ) there was a higher incidence of neurologic deficit with fracture-dislocations and a higher incidence of neurologically intact patients with compression and flexion-distraction injuries ; 3 ) there was a greater incidence of complete neurologic deficits caused by fractures at the spinal cord level , and a diminished incidence at the cauda equina level ; 4 ) for burst fractures there was a weakly positive relationship between canal compromise and neurologic deficit , including bladder function ; 5 ) surgical intervention led to a greater percentage of improved neurologic function than nonoperative treatment , but the rate of improvement was not statistically different ; 6 ) anterior surgery was not more effective than posterior surgery in improving the neurologic function when function was assessed using the Frankel or Motor Index scales , but it was statistically significant when compared to the Manabe scale ; 7 ) in patients who deteriorated before surgery and underwent surgery , there was a greater improvement neurologically , particularly for anterior surgery , compared to those patients treated nonoperatively or to the overall surgically treated group ; 8) There was a statistically significant relationship between bladder function and fracture type , with an increased incidence of absent function seen with fracture-dislocations , of impaired function with burst fractures , and of intact bladder function with compression and flexion-distraction injuries ; 9 ) anterior surgery was more beneficial in improving complete bladder impairment to partial impairment compared to posterior surgery ; 10 ) a kyphotic deformity of greater than 30 degrees at 2-year follow-up was associated with an increased incidence of significant back pain ; 11 ) patients who had surgery complained less of severe pain than those who were treated without surgery 
    Output:
    
The current literature does not provide a reliable answer to whether operative or conservative treatment  is more effective for unstable traumatic thoracolumbar fractures .