Fusion versus Nonfusion for Surgically Treated Thoracolumbar Burst Fractures: A Meta-Analysis

Abstract

BackgroundPosterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fusion could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fusion as a supplement to pedicle screw fixation for thoracolumbar burst fractures.Methodology/Principal FindingsMEDLINE, OVID, Springer, and Google Scholar were searched for relevant randomized and quasi-randomized controlled trials that compared the clinical and radiological efficacy of fusion versus nonfusion for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. We generated pooled risk ratios or weighted mean differences across studies. Based on predefined inclusion criteria, 4 eligible trials with a total of 220 patients were included in this meta-analysis. The mean age of the patients was 35.1 years. 96.8% of the fractures were located at T12 to L1 level. Baseline characteristics were similar between the fusion and nonfusion groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The pooled data showed that the nonfusion group was associated with significantly reduced operative time (p<0.0001) and blood loss (p = 0.0003).Conclusions/SignificancesThe results of this meta-analysis suggested that fusion was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.

Fusion May Not Be a Necessary Procedure for Surgically Treated Burst Fractures of the Thoracolumbar and Lumbar Spines

“…There continues to be considerable controversy regarding the treatment of burst fractures of the thoracolumbar and lumbar spine [2][3][4][5][6][7][8] . Nonoperative treatment for burst fractures without neurologic deficit has been reported to yield good results, although a greater residual kyphotic angle was noted [7][8][9][10][11] . However, greater residual deformity does not correlate with symptoms at the time of follow-up 9 .…”

Instrumented Spinal Stabilization without Fusion for Spinal Metastatic Disease

“…Operative time, as well as total blood loss, may decrease. 44 The risk of further destabilization of the spinal column caused by posterolateral decortication as part of the fusion procedure is eliminated. The possibility that the fusion substrate could stimulate the growth of cancer cells is removed.…”

Temporary stabilization of unstable spine fractures

“…A systematic review of the literature concerning fusion versus non-fusion in the treatment of unstable thoracolumbar fractures from up to 2012 by Tian et al showed that the average hardware failure rate was 5%. Pooled estimates failed to show that the fusion group achieved less implant failure when compared to non-fusion (p = 0.28) [38].…”

“…Although the use of allograph in place of autograph eliminates donor site pain and complications, costs are elevated and fusion potential may be negatively affected [39]. The length of surgery is also increased by fusion surgery which increases operative costs and may influence infection rates [38,40].…”

“…Postoperative blood loss has been documented to be higher in the fusion groups compared to the non-fusion groups in nearly every study [38,41]. The increase in intraoperative blood loss raises the need for perioperative blood transfusion which imparts inherent risk to patients due to a higher rate of infection, transfusion reactions, and blood-transmitted diseases [42].…”