Schnake, Klaus JKlaus JSchnakeDvorak, Marcel FMarcel FDvorakÖner, Cumhur FCumhur FÖnerDandurand, CharlotteCharlotteDandurandMuijs, SanderSanderMuijsBigdon, SebastianSebastianBigdon2024-10-262024-10-262024-02https://boris-portal.unibe.ch/handle/20.500.12422/174256STUDY DESIGN Cross-sectional survey study. OBJECTIVE To investigate factors affecting decision-making in thoracolumbar burst-fractures without neurologic deficit. METHODS A 40-question survey addressing expert-related, economic, and radiological factors was distributed to 30 international trauma experts. Descriptive statistics were used to assess the impact of these factors on operative or non-operative management preferences. RESULTS Out of 30 experts, 27 completed the survey. The majority of respondents worked at level 1 trauma centers (81.5%) within university settings (77.8%). They were primarily orthopedic surgeons (66.7%) and had over 10 years of experience (70.4%). About 81% found distinguishing between A3 and A4 fractures relevant for decision-making. Most experts (59%) treated A3 fractures non-surgically, while only 30% treated A4 fractures conservatively. Compensation systems did not influence treatment recommendations, and hospital measures promoting surgeries did not significantly affect distribution. Radiological factors, such as local kyphosis (25/27), fracture comminution (23/27), overall sagittal balance (21/27), and spinal canal narrowing (20/27), influenced decisions. CONCLUSION Incomplete burst fractures (A3) are predominantly treated non-surgically, while complete burst fractures (A4) are primarily treated surgically. Compensation, third-party incentives, and outpatient care did not significantly impact decision-making. Radiological factors beyond the AO Spine thoracolumbar classification system seem to be essential and warrant further evaluation.enA3/A4 back injuries burst fractures compensation decision-making equipoise radiographic factors spinal Injuries spinal fractures therapy600 - Technology::610 - Medicine & healtharticle10.48350/1926853832459610.1177/21925682231211286