Years ago, I was in a car accident and suffered a broken leg and burst fractures of the spine. At that time, I was given the choice of having surgery to repair the vertebrae or casting and bedrest. I chose the more conservative route. I still have some back pain and mild disability. I’ve always wondered if I took the wrong treatment. Maybe I should have had that operation after all. Is there any way to tell?

There’s no way to know for sure what the results might have been for you if you had opted for surgery. Studies of burst fractures over the years have reported good to excellent results with conservative care.

One study from Sweden followed patients treated nonoperatively for thoracic or lumbar burst fractures for up to 41 years. More than half had an excellent result with no pain or loss of function. One-third of the patients had mild symptoms years later. Twenty per cent reported moderate to severe pain.

When these results were compared with adults of the same age who didn’t have a back injury, the number of people with back pain was about the same. So, the burst fracture didn’t seem to increase the risk of back pain later in life.

The only exception was for those patients who suffered paralysis as a result of the fracture. Their symptoms did not improve. Patients who had mild to moderate neurologic involvement did improve gradually during the follow-up period.

There aren’t very many studies of patients with this type of injury and treatment. From what has been reported, it looks like patients who have surgery get back on their feet faster. Their recovery time is shorter, and they return to work sooner. But the final results years later are no different from those who did not have surgery.