Meta-Analysis of Anterior Surgery versus Posterior Surgery for Thoracolumbar Burst Fractures

2016 ◽  
Vol 13 (1) ◽  
pp. 678-687
Author(s):  
YuWen Jiang ◽  
Hong Xia ◽  
HaiFeng Liu ◽  
QiuGen Hu ◽  
Guang Zheng ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Anterior Surgery ◽  
Thoracolumbar Burst Fractures ◽  
Posterior Surgery ◽  
Burst Fractures

scholarly journals Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

2017 ◽  
Vol 11 (1) ◽  
pp. 150-160 ◽  
Author(s):  
Tarek Ahmed Aly
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Meta Analysis ◽  
Pedicle Screw Fixation ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Significant Difference

<p>Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.</p>

scholarly journals THORACOLUMBAR BURST FRACTURES, SHORT X LONG FIXATION: A META-ANALYSIS

2016 ◽  
Vol 15 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Carlos Alberto Assunção Filho ◽  
Filipe Cedro Simões ◽  
Gabriel Oliveira Prado
Keyword(s):  
Blood Loss ◽  
Clinical Outcomes ◽  
Postoperative Period ◽  
Operative Time ◽  
Meta Analysis ◽  
Thoracolumbar Burst Fractures ◽  
Kyphosis Correction ◽  
Burst Fractures ◽  
Significant Difference

ABSTRACT The number of fixed segments in the surgical treatment of thoracolumbar burst fractures remains controversial. This study aims to compare the results of short and long fixation in thoracolumbar burst fractures through a meta-analysis of studies published recently. MEDLINE and Cochrane databases were used. Randomized controlled trials and non-randomized comparative studies (prospective and retrospective) were selected. Data were analyzed with the software Review Manager. There was no statistically significant difference in the Cobb angle of preoperative kyphosis. Long fixation showed lower average measurements postoperatively (MD = 1.41; CI = 0.73-2.08; p<0.0001) and in the last follow-up (MD = 3.98; CI = 3.22-4.75; p<0.00001). The short fixation showed the highest failure rates (RD = 4.03; CI = 1.33-12.16; p=0.01) and increased loss of height of the vertebral body (MD = 1.24; CI = 0.49-1.98; p=0.001), with shorter operative time (MD = -24.54; CI = -30.16 - -18.91; p<0.00001). There was no significant difference in blood loss and clinical outcomes. The high rates of kyphosis correction loss with short fixation and the lower correction rate in the immediate postoperative period were validated. There was no significant difference in the blood loss rates because arthrodesis was performed in a short segment in the analyzed studies. The short fixation was performed in a shorter operative time, as expected. No study has shown superior clinical outcomes. The short fixation had worse rates of kyphosis correction in the immediate postoperative period, and increased loss of correction in long-term follow-up, making the long fixation an effective option in the management of this type of fracture.

scholarly journals Implant Removal Versus Implant Retention Following Posterior Surgical Stabilization of Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110054
Author(s):  
Barry Ting Sheen Kweh ◽  
Terence Tan ◽  
Hui Qing Lee ◽  
Martin Hunn ◽  
Susan Liew ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Implant Removal ◽  
Correction Loss ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Retention Group ◽  
Significant Difference ◽  
Implant Retention ◽  
Removal Group

Study Design: Systematic review and meta-analysis. Objectives: To compare biomechanical and functional outcomes between implant removal and implant retention following posterior surgical fixation of thoracolumbar burst fractures. Methods: A search of the MEDLINE, EMBASE, Google Scholar and Cochrane Databases was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: Of the 751 articles initially retrieved, 13 published articles pooling 673 patients were included. Meta-analysis revealed there was a statistically significant improvement in sagittal Cobb Angle by 16.48 degrees (9.13-23.83, p < 0.01) after surgical stabilization of thoracolumbar burst fractures. This correction decremented to 9.68 degrees (2.02-17.35, p < 0.01) but remained significant at the time of implant removal approximately 12 months later. At final follow-up, the implant removal group demonstrated a 10.13 degree loss (3.00-23.26, p = 0.13) of reduction, while the implant retention group experienced a 10.17 degree loss (1.79-22.12, p = 0.10). There was no statistically significant difference in correction loss between implant retention and removal cohorts (p = 0.97). Pooled VAS scores improved by a mean of 3.32 points (0.18 to 6.45, p = 0.04) in the combined removal group, but by only 2.50 points (-1.81 to 6.81, p = 0.26) in the retention group. Oswestry Disability Index scores also improved after implant removal by 7.80 points (2.95-12.64, p < 0.01) at 1 year and 11.10 points (5.24-16.96, p < 0.01) at final follow-up. Conclusions: In younger patients with thoracolumbar burst fractures who undergo posterior surgical stabilization, planned implant removal results in superior functional outcomes without significant difference in kyphotic angle correction loss compared to implant retention.

scholarly journals Kyphotic deformity correction of different operative approaches in patients with thoracolumbar burst fractures: a meta-analysis

2020 ◽  
Vol 185 ◽  
pp. 03040
Author(s):  
Wenbin Xuan ◽  
Junyi Ma ◽  
Ruiyun Liao
Keyword(s):  
Cobb Angle ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Treatment Options ◽  
Deformity Correction ◽  
Treatment Method ◽  
Kyphotic Deformity ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Angle Correction

Background: As a common traumatic disease in spine surgery, thoracolumbar burst fractures (TLBF) often leads to complications such as back pain, kyphotic deformity and nerve damage, causing severe physical defects and economic burden on patients. Objective: To explore kyphotic deformity correction of different operative approaches for TLBF. Design of research: Systematic review and meta-analysis are utilized to compare the efficacy of different approaches for postoperative kyphotic deformity in TLBF patients. Methods: English documents that discussed TLBF with different operative approaches were searched from various databases. The obtained documents were screened and evaluated. Results: The comparison and analysis of preoperative Cobb angle, early-postoperative Cobb angle correction, and follow-up Cobb angle correction between the anterior and posterior approach groups showed no statistical significance [MD=0.97, 95% CI (-0.44, 2.38), P=0.18; MD=0.25, 95% CI (-0.04, 0.54), P=0.10; MD=-0.12, 95% CI (-0.44, 0.19), P=0.45]. Conclusion: While treating TLBF symptoms, both the anterior and posterior approaches were effective in correcting postoperative kyphosis deformity. Therefore, while determining a treatment method, the age and the tolerance to the surgery of each patient should be considered for the surgical treatment options. This study provides new ideas for clinical treatment of TLBF in the future.

scholarly journals Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis on the Anterior and Posterior Approaches

2021 ◽  
Author(s):  
Andres Roblesgil-Medrano ◽  
Eduardo Tellez-Garcia ◽  
Luis Carlos Bueno-Gutierrez ◽  
Juan Bernardo Villarreal-Espinosa ◽  
Cecilia Anabell Galindo-Garza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures

scholarly journals Combined Anterior-Posterior Surgery Versus Posterior Surgery for Thoracolumbar Burst Fractures: A Systematic Review of the Literature

2010 ◽  
Vol 4 (1) ◽  
pp. 93-100 ◽  
Author(s):  
Pim P. Oprel ◽  
Wim E Tuinebreijer ◽  
Peter Patka ◽  
Dennis den Hartog
Keyword(s):  
Posterior Approach ◽  
Randomized Clinical Trials ◽  
Burst Fracture ◽  
Cochrane Central Register ◽  
Review Of The Literature ◽  
Thoracolumbar Burst Fractures ◽  
Posterior Surgery ◽  
Burst Fractures ◽  
Posterior Group ◽  
Anterior Posterior

Study Design: A systematic quantitative review of the literature. Objective: To compare combined anterior-posterior surgery versus posterior surgery for thoracolumbar fractures in order to identify better treatments. Summary of Background Data: Axial load of the anterior and middle column of the spine can lead to a burst fracture in the vertebral body. The management of thoracolumbar burst fractures remains controversial. The goals of operative treatment are fracture reduction, fixation and decompressing the neural canal. For this, different operative methods are developed, for instance, the posterior and the combined anterior-posterior approach. Recent systematic qualitative reviews comparing these methods are lacking. Methods: We conducted an electronic search of MEDLINE, EMBASE, LILACS and the Cochrane Central Register for Controlled Trials. Results: Five observational comparative studies and no randomized clinical trials comparing the combined anteriorposterior approach with the posterior approach were retrieved. The total enrollment of patients in these studies was 755 patients. The results were expressed as relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes with 95% confidence intervals (CI). Conclusions: A small significantly higher kyphotic correction and improvement of vertebral height (sagittal index) observed for the combined anterior-posterior group is cancelled out by more blood loss, longer operation time, longer hospital stay, higher costs and a possible higher intra- and postoperative complication rate requiring re-operation and the possibility of a worsened Hannover spine score. The surgeons’ choices regarding the operative approach are biased: worse cases tended to undergo the combined anterior-posterior approach.

Sign in / Sign up

Export Citation Format

Share Document