Gender Differences in Outcomes in Patients Treated for Thoracolumbar Burst Fractures Without Neurological Deficits: Prospective International Multicenter Study.

Authors

• Charlotte Dandurand
• Marcel F Dvorak
• Cumhur F Öner
• Dimitri Hauri
• Klaus Schnake
• Alexander R Vaccaro
• Lorin M Benneker
• Gregory D Schroeder
• Shanmuganathan Rajasekaran
• Mohammad El-Skarkawi
• Rishi M Kanna
• Eugen Cezar Popescu
• Jin Wee Tee
• Andrei Fernandes Joaquim
• Harvinder Singh Chhabra
• Ulrich Spiegl
• Richard J Bransford

Publication/Presentation Date

4-4-2025

Abstract

BACKGROUND AND OBJECTIVES: Exploring gender differences in outcomes after spinal surgery is essential. We aimed to assess gender differences in patients treated for thoracolumbar burst fractures without neurological deficit regarding Oswestry Disability Index (ODI) improvement. Secondarily, we assessed baseline characteristics, treatment selection, and other patient-reported outcomes.

METHODS: Data were prospectively collected. The primary end point was defined as time to achieve minimal clinically important difference (MCID) in ODI. In an exploratory analysis, we defined improvement in ODI as reaching minimal disability.

RESULTS: Genders had similar baseline characteristics, injury characteristics, and treatment selection and timing.Surgically treated women showed a faster achievement of MCID in ODI (14 days, 95% CI 14.0-28.0 vs 28 days, 95% CI 15.0-34.0, P = .009). On multivariable modeling, nonoperatively treated women had a lower chance of achieving improvement in the ODI than nonoperatively treated men (hazard ratio 0.55, 95% CI: 0.32-0.96, P = .036).Women had a longer median time to achieve minimal disability (102.0 days, 95% CI: 76.0; 131.0 vs 62.0 days, 95% CI: 51.0; 72.0, P = .008). Nonoperative women had a longer median time to achieve minimal disability (130.0 days, 95% CI: 82.0-185.0 vs 61.0 days, 95% CI: 47.0-76.0, P = .048). On multivariable modeling, nonoperative women had a lower chance for achieving minimal disability than nonoperatively treated men (hazard ratio 0.55, 95% CI 0.31-0.98 P = .042).

CONCLUSION: This novel study reports gender differences in thoracolumbar burst fractures in neurologically intact patient. Women do worse with nonoperative management than men. In addition, women do better with operative than nonoperative management in achieving MCID, whereas this was not observed in men. Thus, women benefit to a greater extent from surgical management than do men. These results highlight the importance of personalized treatment that incorporates gender. Future studies should assess gender differences in other traumatic spinal pathologies.

Volume

97

Issue

3

First Page

627

Last Page

648

ISSN

1524-4040

Published In/Presented At

Dandurand, C., Dvorak, M. F., Öner, C. F., Hauri, D., Schnake, K., Vaccaro, A. R., Benneker, L. M., Schroeder, G. D., Rajasekaran, S., El-Skarkawi, M., Kanna, R. M., Popescu, E. C., Tee, J. W., Joaquim, A. F., Chhabra, H. S., Spiegl, U., & Bransford, R. J. (2025). Gender Differences in Outcomes in Patients Treated for Thoracolumbar Burst Fractures Without Neurological Deficits: Prospective International Multicenter Study. Neurosurgery, 97(3), 627–648. https://doi.org/10.1227/neu.0000000000003408

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

40183559

Department(s)

Administration and Leadership

Document Type

Article