Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review
The aim of this systematic review was to evaluate the surgical, radiological, and functional outcomes of posterior-only versus combined anterior-posterior approaches in patients with traumatic thoracolumbar burst fractures. The ideal approach (anterior-only, posterior-only, or combined anterior-post...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Spine Society
2020-06-01
|
| Series: | Asian Spine Journal |
| Subjects: | |
| Online Access: | http://www.asianspinejournal.org/upload/pdf/asj-2019-0203.pdf |
| _version_ | 1818127867527036928 |
|---|---|
| author | Terence Tan Tom J. Donohoe Milly Shu-Jing Huang Joost Rutges Travis Marion Joseph Mathew Mark Fitzgerald Jin Tee |
| author_facet | Terence Tan Tom J. Donohoe Milly Shu-Jing Huang Joost Rutges Travis Marion Joseph Mathew Mark Fitzgerald Jin Tee |
| author_sort | Terence Tan |
| collection | DOAJ |
| description | The aim of this systematic review was to evaluate the surgical, radiological, and functional outcomes of posterior-only versus combined anterior-posterior approaches in patients with traumatic thoracolumbar burst fractures. The ideal approach (anterior-only, posterior-only, or combined anterior-posterior) for the surgical management of thoracolumbar burst fracture remains controversial, with each approach having its advantages and disadvantages. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed (registration no., CRD42018115120). The authors reviewed comparative studies evaluating posterior-only approach compared with combined anterior-posterior approaches with respect to clinical, surgical, radiographic, and functional outcome measures. Five retrospective cohort studies were included. Postoperative neurological deterioration was not reported in either group. Operative time, estimated blood loss, and postoperative length of stay were increased among patients in the combined anterior-posterior group in one study and equivalent between groups in another study. No significant difference was observed between the two approaches with regards to long-term postoperative Cobb angle (mean difference, −0.2; 95% confidence interval, −5.2 to 4.8; p =0.936). Moreover, no significant difference in functional patient outcomes was observed in the 36item Short-Form Health Survey, Visual Analog Scale, and return-to-work rates between the two groups. The available evidence does not indicate improved clinical, radiologic (including kyphotic deformity), and functional outcomes in the combined anterior-posterior and posterior-only approaches in the management of traumatic thoracolumbar burst fractures. Further studies are required to ascertain if a subset of patients will benefit from a combined anterior-posterior approach. |
| first_indexed | 2024-12-11T07:24:11Z |
| format | Article |
| id | doaj.art-497cafd9ac4947b28fae740bc53e348b |
| institution | Directory Open Access Journal |
| issn | 1976-1902 1976-7846 |
| language | English |
| last_indexed | 2024-12-11T07:24:11Z |
| publishDate | 2020-06-01 |
| publisher | Korean Spine Society |
| record_format | Article |
| series | Asian Spine Journal |
| spelling | doaj.art-497cafd9ac4947b28fae740bc53e348b2022-12-22T01:16:00ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462020-06-0114338839810.31616/asj.2019.02031149Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic ReviewTerence Tan0Tom J. Donohoe1Milly Shu-Jing Huang2Joost Rutges3Travis Marion4Joseph Mathew5Mark Fitzgerald6Jin Tee7 National Trauma Research Institute, Melbourne, VIC, Australia National Trauma Research Institute, Melbourne, VIC, Australia National Trauma Research Institute, Melbourne, VIC, Australia Department of Orthopaedics, Erasmus MC, Rotterdam, Netherlands Division of Orthopaedic Surgery, Northern Ontario School of Medicine, Sudbury, ON, Canada National Trauma Research Institute, Melbourne, VIC, Australia National Trauma Research Institute, Melbourne, VIC, Australia National Trauma Research Institute, Melbourne, VIC, AustraliaThe aim of this systematic review was to evaluate the surgical, radiological, and functional outcomes of posterior-only versus combined anterior-posterior approaches in patients with traumatic thoracolumbar burst fractures. The ideal approach (anterior-only, posterior-only, or combined anterior-posterior) for the surgical management of thoracolumbar burst fracture remains controversial, with each approach having its advantages and disadvantages. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed (registration no., CRD42018115120). The authors reviewed comparative studies evaluating posterior-only approach compared with combined anterior-posterior approaches with respect to clinical, surgical, radiographic, and functional outcome measures. Five retrospective cohort studies were included. Postoperative neurological deterioration was not reported in either group. Operative time, estimated blood loss, and postoperative length of stay were increased among patients in the combined anterior-posterior group in one study and equivalent between groups in another study. No significant difference was observed between the two approaches with regards to long-term postoperative Cobb angle (mean difference, −0.2; 95% confidence interval, −5.2 to 4.8; p =0.936). Moreover, no significant difference in functional patient outcomes was observed in the 36item Short-Form Health Survey, Visual Analog Scale, and return-to-work rates between the two groups. The available evidence does not indicate improved clinical, radiologic (including kyphotic deformity), and functional outcomes in the combined anterior-posterior and posterior-only approaches in the management of traumatic thoracolumbar burst fractures. Further studies are required to ascertain if a subset of patients will benefit from a combined anterior-posterior approach.http://www.asianspinejournal.org/upload/pdf/asj-2019-0203.pdfthoracic vertebraelumbar vertebraespinal fracturesfracture fixation |
| spellingShingle | Terence Tan Tom J. Donohoe Milly Shu-Jing Huang Joost Rutges Travis Marion Joseph Mathew Mark Fitzgerald Jin Tee Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review Asian Spine Journal thoracic vertebrae lumbar vertebrae spinal fractures fracture fixation |
| title | Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review |
| title_full | Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review |
| title_fullStr | Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review |
| title_full_unstemmed | Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review |
| title_short | Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review |
| title_sort | does combined anterior posterior approach improve outcomes compared with posterioronly approach in traumatic thoracolumbar burst fractures a systematic review |
| topic | thoracic vertebrae lumbar vertebrae spinal fractures fracture fixation |
| url | http://www.asianspinejournal.org/upload/pdf/asj-2019-0203.pdf |
| work_keys_str_mv | AT terencetan doescombinedanteriorposteriorapproachimproveoutcomescomparedwithposterioronlyapproachintraumaticthoracolumbarburstfracturesasystematicreview AT tomjdonohoe doescombinedanteriorposteriorapproachimproveoutcomescomparedwithposterioronlyapproachintraumaticthoracolumbarburstfracturesasystematicreview AT millyshujinghuang doescombinedanteriorposteriorapproachimproveoutcomescomparedwithposterioronlyapproachintraumaticthoracolumbarburstfracturesasystematicreview AT joostrutges doescombinedanteriorposteriorapproachimproveoutcomescomparedwithposterioronlyapproachintraumaticthoracolumbarburstfracturesasystematicreview AT travismarion doescombinedanteriorposteriorapproachimproveoutcomescomparedwithposterioronlyapproachintraumaticthoracolumbarburstfracturesasystematicreview AT josephmathew doescombinedanteriorposteriorapproachimproveoutcomescomparedwithposterioronlyapproachintraumaticthoracolumbarburstfracturesasystematicreview AT markfitzgerald doescombinedanteriorposteriorapproachimproveoutcomescomparedwithposterioronlyapproachintraumaticthoracolumbarburstfracturesasystematicreview AT jintee doescombinedanteriorposteriorapproachimproveoutcomescomparedwithposterioronlyapproachintraumaticthoracolumbarburstfracturesasystematicreview |