Comparison of anterior and posterior approaches in Treating odontoid fractures: a meta-analysis and systematic review

Abstract

BackgroundOdontoid fractures account for 15%–20% of cervical injuries. Although the operation methods vary in different types, the superiority of overall outcomes of the anterior approach (AA) and posterior approach (PA) in treating odontoid fractures still remains controversial. Thus, a meta-analysis was performed comparing AA and PA for these fractures.MethodsThe relevant studies were searched in PubMed/MEDLINE, Cochrane Library, EMBASE, China Biological Medicine (CBM), and Wanfang Database from the onset of conception to June 2022. Prospective or retrospective comparative studies on AA and PA for odontoid fractures were screened, referring to fusion rates (primary outcomes), complications, and postoperative mortality rates. A meta-analysis of the primary outcomes and a systematic review of other outcomes were performed; the procedure was conducted with Review Manager 5.3.ResultsTwelve articles comrising 452 patients were included, and all publications were retrospective cohort studies. The average postoperative fusion rate was 77.5 ± 17.9% and 91.4 ± 13.5% in AA and PA, respectively, with statistical significance [OR = 0.42 (0.22, 0.80), P = 0.009]. Subgroup analysis showed a difference in fusion rates between AA and PA in the elderly group [OR = 0.16 (0.05, 0.49), P = 0.001]. Five articles referred to postoperative mortality, and the mortality rates of AA (5.0%) and PA (2.3%) showed no statistical difference (P = 0.148). Nine studies referred to complications, with a rate of 9.7%. The incidence of complications in AA and PA groups was comparable (P = 0.338), and the incidence of nonfusion and complications was irrelevant. The prevalent cause of death was myocardial infarction. The time and segmental movement retention of AA were possibly superior to those of PA.ConclusionAA may be superior in regard to operation time and motion retention. There was no difference in complications and mortality rates between the two approaches. The posterior approach would be preferred in consideration of the fusion rate.

Does the Surgical Approach Matter in Treating Odontoid Fractures? A Comparison of Mechanical Complication Rates Between Anterior Versus Posterior Surgical Approaches: A Meta-Analysis and Systematic Review

“… 24) There are conflicting meta-analyses, comparing the clinical outcomes of the anterior and posterior approaches to odontoid fractures. 4 31) Lvov et al 17) showed that anterior odontoid screw fixation had a lower rate of fusion and a higher rate of reoperation with no difference in technical failure or mortality. Bao et al 4) reported that the anterior approach had a shorter operative time and greater motion retention with no difference in complications and mortality.…”

“… 4 31) Lvov et al 17) showed that anterior odontoid screw fixation had a lower rate of fusion and a higher rate of reoperation with no difference in technical failure or mortality. Bao et al 4) reported that the anterior approach had a shorter operative time and greater motion retention with no difference in complications and mortality. The fusion rate, rather than the mechanical complication rate, was primarily used to evaluate the outcome of the surgical treatment of odontoid fractures.…”

“…Each approach has its advantages and disadvantages, and they result in different complications.There have been systemic reviews and meta-analyses, comparing the fusion rates of odontoid fractures. 4 31) However, there is a paucity of studies, comparing the mechanical complications, systemic complications, and mortality rates between the two procedures. Hence, this meta-analysis aimed to compare the mechanical complication rates, other complication rates, and mortality in patients with odontoid fractures, treated via the anterior or posterior approach.…”