Despite extensive research on thoracolumbar fractures, controversy still exists about which approach is the most appropriate. Lack of evidence-based practice may result in patients being treated inappropriately. The objective of study was to perform a systematic review of the effectiveness of the anterior and posterior approaches in the treatment of thoracolumbar fractures. We conducted searches of PubMed and the Cochrane Library, searching for relevant trials up to August 2013 that compared anterior and posterior for the treatment of thoracolumbar fractures. The key words ''anterior,'' ''posterior,'' ''thoracolumbar fracture,'' ''CCT,'' and ''RCT'' were used. We assessed all included literature by using the Cochrane handbook (version 5.1). The results were expressed as the mean difference for continuous outcomes and risk difference for dichotomous outcomes, with a 95% confidence interval, using RevMan version 5.2. There were 3 randomized controlled trials and 11 clinical controlled trials included. The metaanalysis showed no significant difference between groups regarding Cobb angle, the Frankel scale, ASIA/JOA motor score, complications, and number of patients returning to work. Compared with the anterior approach, the posterior approach demonstrated superior canal decompression. In the burst fracture subgroup, operative times were significantly shorter and perioperative blood loss was less in the posterior approach group. The posterior approach is more effective for canal decompression, operative times, and perioperative blood loss. However, because of the lack of randomized controlled trials, and because of large sample size studies, heterogeneity was significant between reports. The optimal treatment for thoracolumbar fractures requires further study.Key words: Anterior -Posterior -Thoracolumbar fracture -Systematic review A pproximately 90% of all spinal fractures occur at the thoracolumbar junction, 1-3 including burst fractures, osteoporotic thoracolumbar vertebral collapse, and chronic thoracolumbar fractures as the primary etiologies. The main treatment modality for thoracolumbar fractures is open reduction and internal fixation. 4 There are two main surgical approaches: anterior and posterior. However, the best approach remains controversial. We aimed to apply the methodology of systematic review and meta-analysis to thoracolumbar fractures in order to evaluate the effectiveness of the anterior versus posterior approach in their treatment. Methods Inclusion and exclusion criteriaInclusion criteria were as follows: (1) patients with T 10~L2 thoracolumbar fractures, with or without neurologic deficit, and a minimum age of 18 years; (2) anterior versus posterior approach was the mode of intervention; (3) more than 10 patients were studied, with a minimum follow-up period of 12 months; (4) article type included randomized controlled trials (RCTs) and clinical controlled trials (CCTs); and (5) evaluation included imaging, neurologic examination, and function index (at least 1 item).Exclusion criteria were ...

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Objective To investigate the early clinical efficacy of rehabilitation training after unilateral biportal endoscopy for lumbar disc herniation and to analyze the prognostic factors. Methods A total of 100 patients with lumbar disc herniation who underwent unilateral biportal endoscopy at The Sixth Affiliated Hospital of Nantong University from January 2019 to January 2021 were retrospectively analyzed. The control group was given a standard home-based exercise program, while the intervention group was given a substituted rehabilitation training opposed to a standard home-based exercise program. The early postoperative pain relief and quality of life values were compared between the two groups, and the independent risk factors affecting the prognosis of patients were analyzed. Results There were no significant differences in sex, age, smoking, drinking, BMI, course of disease, type of disc herniation, preoperative VAS, ODI or SF-36 between the two groups (P > 0.05). There was no significant difference in preoperative and postoperative VAS and ODI scores at 3 months between the two groups (P > 0.05), yet there were significant differences in postoperative VAS and ODI at 12 months (P < 0.05). The SF-36 score of the intervention group was lower than that of the control group at 12 months, and the difference was statistically significant (P < 0.05). The excellent rate of the Macnab standard modification used in the intervention group was 88.00% at 12 months, and that in the control group was 62.00%. The difference between the two groups was considered to indicate a statistically significant (P < 0.05). The results of logistic multivariate regression model analysis showed that rehabilitation training (95% CI: 1.360–12.122, P = 0.012), the type of intervertebral disc (95% CI: 0.010–0.676, P = 0.020), and age (95% CI: 1.056–8.244, P = 0.039) were independent risk factors affecting the prognosis of patients. Conclusion Postoperative rehabilitation training can effectively relieve pain and improve quality of life; thus, it is highly recommended in the clinic. Postoperative rehabilitation training, intervertebral disc type and age are independent risk factors for the postoperative prognosis of lumbar intervertebral disc herniation.