Effective Method of Pedicle Screw Fixation in Patients with Neurologically Intact Thoracolumbar Burst Fractures: A Systematic Review of Studies Published Over the Last 20 Years

Abstract

Objective: To conduct a systematic review of studies focusing on various PSF methods for neurologically intact burst fractures of the thoracic and lumbar spine (TLFS) and identify the most effective and safe approach among them. Methods. Systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study was registered in the PROSPERO (№ CRD42024531093). The inclusion criteria for articles in the systematic review were as follows: 1) publication date between January 1, 2004, and December 31, 2023; 2) availability of the full-text version of the article in English; 3) fracture type A3 or A4 according to the AOSpine classification, or types A, B, or C burst fractures according to the F. Denis classification, or direct indication by the author of the presence of a "burst" fracture without its classification; 4) absence of neurological deficit; 5) patient age over 18 years; 6) description of treatment outcomes or complications; 7) follow-up period of 12 months for patient samples. Results. In total, the 70 articles presented treatment results for 122 groups of patients were included. Statistical analysis demonstrated the advantages of short-segment fixation in terms of operation duration and intraoperative blood loss (p = 0.001 and < 0.001, respectively). It was also found that the frequency of deep infection was significantly higher with extensive fusion compared to other PSF methods (p = 0.043). Percutaneous pedicle screw fixation (PSF) was performed in patients with lower body compression rate and kyphotic deformity values (p = 0.043), had less potential for their correction (p = 0.004), but significantly reduced blood loss (p = 0.011), operation duration (p < 0.0001), and hospitalization period (p < 0.0001). Statistical analysis did not reveal significant advantages of using additional intermediate screws in patients undergoing short-segment PSF. Conclusions. The optimal surgical treatment method for neurologically intact thoracolumbar burst fractures is short-segment, 4-screw pedicle screw fixation. The use of posterior lateral fusion in this context may increase the deep infection rate without reducing the frequency of implant-related complications or affecting long-term treatment outcomes. Percutaneous approach is the preferred technique; however, in patients with severe kyphotic deformities, its lower reduction capabilities should be considered during surgical planning. The application of intermediate screws in patients with neurologically intact thoracolumbar burst fractures did not demonstrate any significant advantages. Removal of the fixation system did not lead to a significant reduction in implant-related complications or improvement in quality of life.