Comparison of Anterior Versus Posterior Approach in the Treatment of Thoracolumbar Fractures: A Systematic Review

Abstract

Despite extensive research on thoracolumbar fractures, controversy still exists about which approach is the most appropriate. Lack of evidence-based practice may result in patients being treated inappropriately. The objective of study was to perform a systematic review of the effectiveness of the anterior and posterior approaches in the treatment of thoracolumbar fractures. We conducted searches of PubMed and the Cochrane Library, searching for relevant trials up to August 2013 that compared anterior and posterior for the treatment of thoracolumbar fractures. The key words ''anterior,'' ''posterior,'' ''thoracolumbar fracture,'' ''CCT,'' and ''RCT'' were used. We assessed all included literature by using the Cochrane handbook (version 5.1). The results were expressed as the mean difference for continuous outcomes and risk difference for dichotomous outcomes, with a 95% confidence interval, using RevMan version 5.2. There were 3 randomized controlled trials and 11 clinical controlled trials included. The metaanalysis showed no significant difference between groups regarding Cobb angle, the Frankel scale, ASIA/JOA motor score, complications, and number of patients returning to work. Compared with the anterior approach, the posterior approach demonstrated superior canal decompression. In the burst fracture subgroup, operative times were significantly shorter and perioperative blood loss was less in the posterior approach group. The posterior approach is more effective for canal decompression, operative times, and perioperative blood loss. However, because of the lack of randomized controlled trials, and because of large sample size studies, heterogeneity was significant between reports. The optimal treatment for thoracolumbar fractures requires further study.Key words: Anterior -Posterior -Thoracolumbar fracture -Systematic review A pproximately 90% of all spinal fractures occur at the thoracolumbar junction, 1-3 including burst fractures, osteoporotic thoracolumbar vertebral collapse, and chronic thoracolumbar fractures as the primary etiologies. The main treatment modality for thoracolumbar fractures is open reduction and internal fixation. 4 There are two main surgical approaches: anterior and posterior. However, the best approach remains controversial. We aimed to apply the methodology of systematic review and meta-analysis to thoracolumbar fractures in order to evaluate the effectiveness of the anterior versus posterior approach in their treatment. Methods Inclusion and exclusion criteriaInclusion criteria were as follows: (1) patients with T 10~L2 thoracolumbar fractures, with or without neurologic deficit, and a minimum age of 18 years; (2) anterior versus posterior approach was the mode of intervention; (3) more than 10 patients were studied, with a minimum follow-up period of 12 months; (4) article type included randomized controlled trials (RCTs) and clinical controlled trials (CCTs); and (5) evaluation included imaging, neurologic examination, and function index (at least 1 item).Exclusion criteria were ...

Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review

“…The surgeon has to determine the best approach (i.e., anterior-only, posterior-only, or combined anterior-posterior), each with their relative advantages and disadvantages. A comparison between isolated anterior and posterior approaches has been the focus of previous systematic reviews and are outside the scope of this study [10,11]. These reviews have largely found no differences in terms of the neurological, functional, and quality-of-life outcomes between the anterior-only and the posterior-only approaches.…”

Anterior versus posterior approach in traumatic thoracolumbar burst fractures deemed for surgical management: Systematic review and meta-analysis

“…fractures that focuses specifically on true burst fractures only. Previous review articles have included fractures of differing morphologies and pathologies(21,22). The present review, by focusing on burst fractures only, improves the generalizability of the recommendations made.A comprehensive evaluation of treatment outcomes is made possible by both qualitative and quantitative meta-analysis of the results.…”

Operative versus Non-Operative Management of Traumatic Thoracolumbar Injuries according to the AO Spine Thoracolumbar Spine Injury Classification System

“…2,19,23 Anterior, posterior, and combined approaches have been described, although posterior approaches present potentially less complications. 2,19,23 We did not find any recent study proposing nonoperative management for burst fractures in neurologically-compromised patients. With few exceptions, a mild radiculopathy (N2) associated with a burst fracture may be treated nonoperatively.…”