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Title: Anterior versus posterior approach in traumatic thoracolumbar burst fractures deemed for surgical management: Systematic review and meta-analysis.
Austin Authors: Tan, Terence;Rutges, Joost;Marion, Travis;Gonzalvo, Augusto ;Mathew, Joseph;Fitzgerald, Mark;Dvorak, Marcel;Schroeder, Gregory;Tee, Jin
Affiliation: Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, USA
Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada
Division of Orthopaedic Surgery, Northern Ontario School of Medicine, Ontario, Canada
Department of Orthopaedics, Erasmus MC, Rotterdam, Netherlands
National Trauma Research Institute, Melbourne, Victoria, Australia
Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
Issue Date: Dec-2019 2019-08-17
Publication information: Journal of Clinical Neuroscience 2019; 70: 189-197
Abstract: Uncertainties remain regarding the optimal surgical approach in the treatment of traumatic thoracolumbar burst fractures. We aim to compare the surgical, radiological and functional outcomes in anterior versus posterior approaches in patients with traumatic thoracolumbar burst fractures deemed for surgical management. A systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Qualitative analysis and where suitable, meta-analysis were performed to compute pooled estimates of the differences between anterior and posterior approaches. A total of six studies (three observational, one prospective non-randomized trial, two randomized controlled trials) were included. There were no cases of postoperative neurological decline. Meta-analysis demonstrates a longer duration (Mean Difference (MD) + 81.68, 95% CI 39.20 to 123.16, p < 0.001) and increased estimated blood loss (MD + 426.27, 95% CI 119.84 to 732.70, p = 0.006) for the anterior approach. No difference between approaches was found regarding length of hospital stay, late postoperative kyphotic angle, construct failure rate, instrumentation revision rate, rate of return to work, and total hospital charges. Limitations include the small number of, and heterogeneity across studies. Given the similarities in neurological, radiological and functional outcomes between the two approaches, the longer duration and estimated blood loss in the anterior approach should be a point of consideration when selecting the surgical approach. There is an urgent need for contemporary, high quality research in this area.
DOI: 10.1016/j.jocn.2019.07.083
PubMed URL: 31431406
Type: Journal Article
Subjects: AO Type A3 & A4
Anterior approach
Burst fracture
Posterior approach
Thoracolumbar fracture
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