Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Aly, Tarek

doi:10.4184/asj.2017.11.1.150

Cited by 67 publications

(61 citation statements)

References 41 publications

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“…Neither xation technique was overwhelmingly superior in terms of long-term e cacy and health-related quality of life. Some published studies also have reported no signi cant difference between long-segment and short-segment xations regarding clinical and radiological outcomes [28]. The comparative assessments in this study supported this nding based on a quantitative analysis of the correction of kyphotic deformities, VAS score for back pain, and SF-36 score for health status, especially mental health.…”

Section: Discussionsupporting

confidence: 85%

Long-segment versus short-segment fixation through a posterior approach for tuberculous spondylodiscitis of the mid-thoracic spine in adults: a study of mid- to long-term efficacy

Wang

Chen

et al. 2020

Preprint

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Background This retrospective study aimed to perform comparatively evaluate the mid- to long-term efficacy of long-segment and short-segment fixations via the posterior approach as treatment for tuberculous spondylodiscitis in the mid-thoracic spine. Methods A total of 95 patients with tuberculous spondylodiscitis in the mid-thoracic spine underwent surgery via the posterior approach including single-stage posterior debridement, interbody fusion, and pedicle screw fixation. Long-segment fixations were performed for 46 patients (group A), while short-segment fixations were performed for the other 49 patients (group B). Clinical and radiological outcomes were assessed during mid- to long-term follow-up. Results The average follow-up periods for groups A and B were 75.5 ± 11.8 and 76.8 ± 11.6 months, respectively. The operative time and intraoperative blood loss were lower in group B than in group A (P < 0.05). Both management approaches significantly corrected the kyphotic deformity detected either in the early postoperative period or at the final visit after long-term follow-up (P > 0.05). Bony fusion was generated after average periods of 10.8 ± 2.1 months and 11.0 ± 2.0 months in groups A and B, respectively. Favorable outcomes were observed on assessment of neurological function and patients’ well-being at the final follow-up. Conclusion No therapeutic differences were observed between long-segment and short-segment fixation as surgical treatment for mid-thoracic Pott’s disease during mid- to long-term follow-up. Kyphotic deformity and neurological impairment were significantly relieved via both posterior fixation approaches, with patients’ well-being reaching a favorable level. Moreover, short-segment fixation led to less blood loss and required a shorter operative time.

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Section: Discussionsupporting

confidence: 85%

Long-segment versus short-segment fixation through a posterior approach for tuberculous spondylodiscitis of the mid-thoracic spine in adults: a study of mid- to long-term efficacy

Wang

Chen

et al. 2020

Preprint

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“…The number of levels fixated posteriorly and the method of posterior instrumented fusion were heterogeneous between the studies in this review (Table 2). However, when considering short-versus longsegment posterior fixation (without anterior fixation) in thoracolumbar burst fractures, a recent meta-analysis by Aly [14] found no difference in the clinical, radiological (including kyphotic deformity), and functional outcomes. In this review, no evidence of a superior neurological outcome or less kyphotic deformity was found when comparing the combined anterior-posterior approach to the posterior-only approach.…”

Section: Discussionmentioning

confidence: 99%

Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review

et al. 2020

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The aim of this systematic review was to evaluate the surgical, radiological, and functional outcomes of posterior-only versus combined anterior-posterior approaches in patients with traumatic thoracolumbar burst fractures. The ideal approach (anterior-only, posterior-only, or combined anterior-posterior) for the surgical management of thoracolumbar burst fracture remains controversial, with each approach having its advantages and disadvantages. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed (registration no., CRD42018115120). The authors reviewed comparative studies evaluating posterior-only approach compared with combined anterior-posterior approaches with respect to clinical, surgical, radiographic, and functional outcome measures. Five retrospective cohort studies were included. Postoperative neurological deterioration was not reported in either group. Operative time, estimated blood loss, and postoperative length of stay were increased among patients in the combined anterior-posterior group in one study and equivalent between groups in another study. No significant difference was observed between the two approaches with regards to long-term postoperative Cobb angle (mean difference, −0.2; 95% confidence interval, −5.2 to 4.8; p =0.936). Moreover, no significant difference in functional patient outcomes was observed in the 36item Short-Form Health Survey, Visual Analog Scale, and return-to-work rates between the two groups. The available evidence does not indicate improved clinical, radiologic (including kyphotic deformity), and functional outcomes in the combined anterior-posterior and posterior-only approaches in the management of traumatic thoracolumbar burst fractures. Further studies are required to ascertain if a subset of patients will benefit from a combined anterior-posterior approach.

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“…21 Many studies with SSPF only in unstable dorsolumbar fractures have reported good results. 8,[22][23][24][25] In our study the mean kyphosis pre operatively was 23.03±11.14 which improved to mean of 7.03±4.59 in immediate postoperative period. At the final follow up the mean kyphosis angle was 11.76±5.90 and there was loss of kyphosis correction of 4.70±2.04 degrees.…”

Section: Discussionmentioning

confidence: 70%

“…[4][5][6][7] Posterior pedicle screw fixation is accepted as a standard treatment method for these fractures owing to less morbidity and all three columns control by pedicle screws but there is controversy in choosing between long segment fixation or short segment fixation. 8 Long segment spinal fixation (2 level above and 2 level below) theoretically has better holding of reduction and less chances of implant failure but more sacrifice of motion segments, more cost more extensive surgery whereas short segment fixation (one level above and one level below) has more chances of fixation failure but lesser sacrifice of motion segment, lesser cost and less extensive surgery. Review of literature has found 5-54% failure rate in short segment posterior fixation.…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of unstable thoracolumbar fractures treated by postural reduction and posterior short segment pedicle fixation

et al. 2019

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Background: For unstable dorslolumbar injuries, the controversy in choosing between long versus short segment posterior fixation continues.Methods: 29 patients (13 males, 16 females) with single level unstable thoracolumbar fracture operated by short segment posterior pedicle screw fixation were evaluated retrospectively in terms of kyphosis correction achieved in immediate post-operative period, loss of kyhposis correction at final follow up and clinical outcome on Denis pain scale and any failure of fixation. Average follow up period was 22.07 months (14-40 months).Results: Average age of patient was 35.7 years (15-50 years). Mode of injury was fall from height in 27 patients and road traffic accident in 2 patients. 12 fractures were at L1, 9 at D12, 6 at L2 and 2 at L3. Neurologically 11 had paraparesis, 4 complete paraplegia and 14 were without any deficit. Pre-operative kyphotic angle was 23.023±11.14 (8-50 degrees) which improved to 7.03±4.69 (0-18) post operatively. Kyphosis at final follow up was 11.759±5.901 (2-25). Loss of kyphosis correction at final follow up was 4.79±2.042 (2-10 degrees). Load sharing classification score (LSC) was 6.89±1.345 (4-9). Denis pain scale at final follow up was p1 in 11 patients, p2 in 15 patients and p3 in 3 patients. There was no case of implant failure and only one case had kyphosis correction loss of 10 degrees.Conclusions: Short segment fixation provides stable fixation with good results and there is no correlation between LSC and fixation failure.

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Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Cited by 67 publications

References 41 publications

Long-segment versus short-segment fixation through a posterior approach for tuberculous spondylodiscitis of the mid-thoracic spine in adults: a study of mid- to long-term efficacy

Long-segment versus short-segment fixation through a posterior approach for tuberculous spondylodiscitis of the mid-thoracic spine in adults: a study of mid- to long-term efficacy

Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review

Retrospective analysis of unstable thoracolumbar fractures treated by postural reduction and posterior short segment pedicle fixation

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