Anterior Versus Posterior Treatment of Stable Thoracolumbar Burst Fractures Without Neurologic Deficit

Abstract

Although patient outcomes are similar, anterior fusion and instrumentation for thoracolumbar burst fractures may present fewer complications or additional surgeries.

Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

“…Such remodeling has been reported for operatively and nonoperatively treated patients, occurring as a result of resorption of intracanal bone fragments [19,24,32,34,42,50,52,54]. Although concerns have been raised regarding inadequate remodeling in an observational study [32], Mumford et al [34] reported substantial remodeling in effectively all canals with greater than 50% compromise in nonoperative trials.…”

“…This is associated with kyphosis progression of 1°to 8.3°, spontaneous spinal canal remodeling (from an average of 26% to 36% compression at the time of injury to 12% to 18% at last followup) [3, 4, 10-14, 27, 41, 44], and rare cases of neurologic deterioration [21,34]. Observational studies of operative treatment suggest the majority of patients experience satisfactory pain and functional outcomes, kyphosis correction of 0.5°to 10.2°, reduction in canal stenosis, and no neurologic deterioration at last followup [1,2,5,10,11,21,27,41,42,52].…”

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

“…There was significant heterogeneity (I 2 = 97 %) among the studies; however, this disappeared after the exclusion of two studies (Lin et al [29] and Wood et al [26]; I 2 = 3 %, Fig. 9).…”

“…Figure 1 shows a flow chart of the study selection and inclusion process. The search strategy identified 679 citations, of which seven satisfied the pre-defined inclusion criteria for data extraction and meta-analysis [23][24][25][26][27][28][29] (Table 1). These studies involved 179 patients in the anterior approach group and 152 patients in the posterior approach group.…”

“…Wood et al [26] and Esses et al [23] compared canal encroachment. At the final follow-up, canal encroachment had improved to a greater extent in the anterior approach group than in the posterior approach group (MD, -8.2; 95 % CI -17.33 to 0.92; P = 0.08; Fig.…”