Analysis of technical options for decompression and stabilization surgery for injuries of the lower thoracic and lumbar spine: a systematic review of the literature

Abstract

The objective of this systematic review was to analyze the clinical efficacy of various technical options for surgical treatment of patients with injuries to the lower thoracic and lumbar spine. The review includes 57 studies published in 2001–2022, which were selected from the main medical databases – PubMed, Medline, and The Cochrane Database of Systematic Reviews. In these publications, five options for surgical intervention were identified, the clinical effectiveness of which was determined by the degree of regression of neurological disorders, the quality of the achieved reposition, the amount of loss of correction within two years after surgery, the number of complications, the duration of operations, and the amount of blood loss. For pairwise comparison between groups, the Kruskal – Wallis test was used for several independent samples, based on the initial determination of the normality of data distribution in groups. To determine the differences between the parameters before and after the operation, the Wilcoxon test was used for two dependent samples. Differences were considered statistically significant at p < 0.05. An analysis of the literature data showed that there are no differences in the dynamics of neurological recovery in patients with spinal cord injury in the thoracic or lower lumbar spine when using five different types of surgical treatment. There are also no differences in the quality of correction of kyphotic deformity of injured spinal motion segments between all studied groups. Statistically significant lower loss of deformity correction is noted in patients who underwent one-stage circumferential decompression through posterolateral approach and decompression through combined approaches. Notably, operations performed through isolated posterior or anterior approaches have comparable values of correction loss. Operations with decompression of the dural sac through the posterior approaches are characterized by a significantly shorter time of surgical intervention than operations with decompression through the anterior and combined approaches. The smallest volume of blood loss is observed during surgery with decompression through isolated posterior approaches. The largest volume of blood loss is in the group with posterolateral approach and one-stage circumferential decompression. Surgical interventions through posterior approach have a statistically significant lower complication rate than operations that include the anterior stage.