Factors associated with quality of life after traumatic thoracolumbar spine injury: a narrative review

Abstract

Background: Traumatic thoracolumbar spine injuries are a major cause of persistent pain, functional limitation, and reduced quality of life (QoL), even in the absence of severe neurological impairment. Although numerous studies have examined individual aspects of outcome after these injuries, the determinants of long-term QoL remain fragmented across the literature. This review aimed to analyse and systematise factors associated with QoL and functional outcomes in adult patients following traumatic thoracolumbar spine injury. Methods: This study was conducted as a narrative review with a structured literature search. PubMed, Embase, and the Cochrane Library were searched using database-specific strategies focused on thoracolumbar fractures, quality of life, functional outcome, deformity, sagittal balance, and other clinically relevant sequelae. Titles, abstracts, and full texts were screened, with eligibility assessment performed independently by three reviewers and disagreements resolved by consensus. Articles published in English were considered eligible. Given the marked clinical and methodological heterogeneity of the available evidence, a quantitative meta-analysis was not performed; instead, the data were synthesised narratively. Results: A total of 154 publications were included. For analytical synthesis, all factors associated with QoL after thoracolumbar spine injury were grouped into five domains: demographic and baseline factors, clinical factors, radiological factors, treatment-related factors, and psychosocial/rehabilitation-related factors. The most consistent adverse predictors of long-term outcome were initial neurological deficit, limited neurological recovery, persistent pain, and functional disability. Additional influential factors included age, comorbidity, osteoporosis, injury severity, sagittal alignment, treatment complications, return to work, psychological status, and the broader psychosocial context. Radiological success alone did not reliably correspond to patient-perceived recovery. Surgical treatment generally provided faster short-term improvement, but its long-term superiority over conservative treatment in stable fractures without neurological deficit remained unproven. Conclusions: Quality of life after traumatic thoracolumbar spine injury is multifactorially determined and cannot be explained by any single clinical, radiological, or technical parameter. Long-term outcome reflects the interaction between injury severity, treatment effectiveness, residual symptoms, and the patient’s capacity for functional, psychological, and social adaptation. These findings support a personalised, multidisciplinary approach to treatment planning and outcome assessment, with greater emphasis on patient-reported outcomes alongside radiological and technical results.