Combined pedicle screw fixation at the fracture level could be an alternative method for thoracolumbar fracture.
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Compared with CFL group, AFL group could achieve better correction efficacy after surgery, so does the long-term effect.
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Compared with CFL group, AFL group was associated with less implant failure.
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More well-designed RCTs are urgently needed to determine the safety of combined pedicle screw fixation at the fracture level.
Abstract
Background
Thoracolumbar fractures is a frequent injury occurring in spinal trauma. Outcomes and complications between combined pedicle screw fixation at the fracture vertebrae (AFV) and conventional method cross the fracture vertebrae (CFV) are still controversial. Thus, this study aimed to evaluate differences in outcome variables between these two operative methods.
Materials and methods
PubMed, Web of Science, Cochrane Library, EMBASE and CNKI were searched with the terms "thoracolumbar fractures", "posterior", "pedicle screw fixation", and "clinical trial" from Jan 1980 to July 2017. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was performed using RevMan 5.3 software.
Results
Eighteen randomized controlled trials involving 1280 patients were eligible. The pooled data revealed that AFV group might be associated with more intraoperative blood loss (MD = 9.84, 95%CI 7.45 to 12.22) and longer operation time (MD = 1.97, 95%CI 0.17 to 3.77) when compared with CFV group. However, AFV group significantly improved visual analogue scale (VAS) (MD = −1.27, 95%CI -1.70 to −0.83), anterior vertebral height (AVH) (MD = 7.58, 95%CI 3.99 to 11.17), short-term Cobb angle (MD = −1.29, 95%CI -2.39 to −0.19), long-term Cobb angle (MD = −4.47, 95%CI -7.30 to −1.63) and loss of long-term correction efficacy (MD = −6.56, 95%CI -7.49 to −5.62) after surgery. Moreover, compared with the CFV group, the AFV group had lower rate of implant failure (MD = 0.16, 95%CI 0.07 to 0.36). Both techniques had similar hospital stay (MD = 0.25, 95%CI -0.52 to 1.03) and postoperative infection (MD = 0.53, 95%CI 0.13 to 2.23).
Conclusions
Though with a more operation time and intraoperative hemorrhage, combined pedicle screw fixation at the fracture veterbrae may be better than traditional fixation cross the fracture level alone for thoracolumbar fractures.
