Comparison of Surgical Outcomes in Thoracolumbar Fractures Operated with Posterior Constructs Having Varying Fixation Length with Selective Anterior Fusion

Kim, Hak-Sun; Lee, Seung Yup; Nanda, Ankur; Kim, Ju Young; Park, Jin Oh; Moon, Seong Hwan; Lee, Hwan Mo; Kim, Ho-Joong; Wei, Huan; Moon, Eun Su

doi:10.3349/ymj.2009.50.4.546

Cited by 22 publications

(22 citation statements)

References 44 publications

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“…Theoretically, the anterior approach offers some benefits such as better canal decompression [16,30]. This approach provides better exposure of the fractured vertebrae, enabling a more thorough decompression [10]. In contrast, the posterior approach can only support indirect decompression [31].…”

Section: Discussionmentioning

confidence: 99%

“…Although many studies have obtained good results with nonoperative treatment of thoracolumbar burst fractures [6][7][8], most authors agree that surgical treatment is required for symptomatic, unstable burst fractures [9,10]. Surgical intervention can decompress neural elements, restore vertebral body height, correct angular deformity and stabilize the spine.…”

Section: Introductionmentioning

confidence: 99%

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Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Xiong

et al. 2013

Eur Spine J

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Purpose To critically review and summarize the literature comparing the results of surgery via an anterior approach and that via a posterior approach for the treatment of thoracolumbar burst fractures to identify the better approach. Methods In this meta-analysis, we conducted electronic searches of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and other databases using the search terms ''thoracolumbar fractures'', ''anterior'', ''posterior'', ''controlled clinical trials''. Relevant journals or conference proceedings were also searched manually. Data extraction and quality assessment were in accordance with Cochrane Collaboration guidelines. The analysis was performed on individual patient data from all the trials that met the selection criteria. Sensitivity analysis was performed when there was significant heterogeneity. Results were expressed as risk difference for dichotomous outcomes and mean difference for continuous outcomes with 95 % confidence interval. Results Four randomized clinical trials and three controlled clinical trials comparing the results of the anterior versus posterior approach in the treatment of thoracolumbar burst fractures were retrieved; these studies included 179 and 152 patients in the anterior and posterior approach groups, respectively. There were no differences in terms of neurological recovery, return to work, complications and Cobb angle between the two groups. The anterior approach was associated with longer operative time, greater blood loss and higher cost than the posterior approach. Conclusions The posterior approach may be more effective than the anterior approach. However, more highquality, randomized controlled trials are required to compare these approaches and guide clinical decision-making. Level of Evidence Level II, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Xiong

et al. 2013

Eur Spine J

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“…15,16 Although many studies have obtained good results with conservative treatment of thoracolumbar burst fractures, [17][18][19] most authors agree that surgical treatment is necessary for unstable burst fractures. 20,21 Surgical intervention can decompress neural elements, restore the height of the vertebral body, correct and prevent angular deformity, and promote stability of the vertebral spine, allowing early mobilization and promoting neurological improvement. 22,23 The best option for surgical treatment of thoracolumbar fractures remains controversial, despite the greater knowledge of biomechanics and advances in surgical techniques.…”

Section: Introductionmentioning

confidence: 99%

Thoracolumbar Burst Fractures, Short X Long Fixation: A Meta-Analysis

Filho¹,

Simões²,

Prado³

2016

Coluna/Columna

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Thoracolumbar bursT fracTures, shorT x long fixaTion: a meTa-analysis Fraturas toracolombares do tipo explosão, Fixação curta x longa: uma metanálise Fracturas toracolumbares tipo explosión, Fijación corta x larga: un meta-análisis 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.

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“…However, anterior and combined front/back surgical approaches are still commonly employed. 6 There are major disadvantages for the posterior approach surgery. The first one is the usually insufficient indirect spinal canal clearance obtained by annulotaxis.…”

Section: Discussionmentioning

confidence: 99%

“…The third disadvantage is a frequent failure of pedicle screw fixation techniques, which happens even in cases in which a laminectomy has not been performed. 6,15 The anterior approach minimizes damage to the posterior ligamentous structures of the spine. The primary indication for an anterior decompression is an incomplete neurologic deficit with marked canal compromise and intact posterior ligamentous complex.…”

Section: Discussionmentioning

confidence: 99%

Anterior Approach for Lesions in the Thoracolumbar Area: Evaluation of the Clinical and Radiological Outcome

Farag

Elawady

2012

Egyptian Spine Journal

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Background Data: The primary indications for anterior approach in vertebral surgery include the conditions associated with the destruction of one or more vertebral bodies and intervertebral discs, vertebral fractures, and deformities. Purpose: To evaluate the clinical and radiological outcome of the anterior surgical approach in the management of lesions of the thoracolumbar area. Study Design: A retrospective clinical case study and a literature review. a total of 15 patients admitted and surgically treated for thoracolumbar spine lesion. All patients underwent anterior thoracolumbar fixation surgery. Data were analyzed retrospectively. The outcome was evaluated with (ASIA) scale after three months, six months and one year following surgery. Plain x-Ray both anteroposterior and lateral views and 3D Computed Tomography were done postoperatively. Results: Fifteen patients, 10 males and 5 females with ages ranging from 17 to 70 years were included in this study. They were operated upon for traumatic fracture in 10 patients and TB spondylodiscitis in 5 patients in the thoracolumbar area. The average operative time was 4 hours. The average postoperative hospitalization was 14.5 days. According to ASIA; patients grade A (N=5), and E (N=2) remained the same post-operatively, whereas, of the other patients with incomplete cord lesion (N=8), six improved one grade and two did not improve. The preoperative segmental kyphosis improved postoperatively at the three-month visit from a mean of 26.2 o to a mean of 11 o . Conclusion: Anterolateral approach can be an effective means of treating thoracolumbar spine lesions. It allows better safe decompression of neural structures. The titanium cage and Z-Plate system provide efficient stability and allows for early mobilization. (2012ESJ030)

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Comparison of Surgical Outcomes in Thoracolumbar Fractures Operated with Posterior Constructs Having Varying Fixation Length with Selective Anterior Fusion

Cited by 22 publications

References 44 publications

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Thoracolumbar Burst Fractures, Short X Long Fixation: A Meta-Analysis

Anterior Approach for Lesions in the Thoracolumbar Area: Evaluation of the Clinical and Radiological Outcome

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