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Letters to the Editor   |    
Operative Compared with Nonoperative Treatment of a Thoracolumbar Burst Fracture without Neurological Deficit
Michael Wettstein, MD; Elyazid Mouhsine, MD
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The authors did not receive grants or outside funding in support of their research or preparation of this work. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Mar 01;86(3):651-652
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To The Editor:We read with interest the article entitled "Operative Compared with Nonoperative Treatment of a Thoracolumbar Burst Fracture without Neurological Deficit. A Prospective, Randomized Study" (2003; 85:773-81), by Wood et al.The authors speak about "stable" burst fractures of the thoracolumbar junction. The inclusion criteria included the absence of a posterior column lesion (except for a laminar fracture, which was neither an exclusionary criterion nor a contraindication for nonoperative treatment). The first definition categorizes the fractures as burst type-A3 fractures according to the AO classification system1, which is widely used. A laminar fracture, however, indicates a posterior column lesion, thereby categorizing the fracture as type B1 according to the AO classification1. According to the criteria described by Denis2 and Louis and Goutallier3, a type-A3 burst fracture, by definition, represents an unstable lesion as two of three columns are involved and a type-B1 fracture represents a highly unstable lesion as three columns are involved. Therefore, we think that it is incorrect to speak about a "stable" burst fracture.
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