Thoracolumbar Burst Fractures, Short X Long Fixation: A Meta-Analysis

Abstract

Thoracolumbar bursT fracTures, shorT x long fixaTion: a meTa-analysis Fraturas toracolombares do tipo explosão, Fixação curta x longa: uma metanálise Fracturas toracolumbares tipo explosión, Fijación corta x larga: un meta-análisis ABSTRACT The number of fixed segments in the surgical treatment of thoracolumbar burst fractures remains controversial. This study aims to compare the results of short and long fixation in thoracolumbar burst fractures through a meta-analysis of studies published recently. MEDLINE and Cochrane databases were used. Randomized controlled trials and non-randomized comparative studies (prospective and retrospective) were selected. Data were analyzed with the software Review Manager. There was no statistically significant difference in the Cobb angle of preoperative kyphosis. Long fixation showed lower average measurements postoperatively (MD = 1.41; CI = 0.73-2.08; p<0.0001) and in the last follow-up (MD = 3.98; CI = 3.22-4.75; p<0.00001). The short fixation showed the highest failure rates (RD = 4.03; CI = 1.33-12.16; p=0.01) and increased loss of height of the vertebral body (MD = 1.24; CI = 0.49-1.98; p=0.001), with shorter operative time (MD = -24.54; CI = -30.16 --18.91; p<0.00001). There was no significant difference in blood loss and clinical outcomes. The high rates of kyphosis correction loss with short fixation and the lower correction rate in the immediate postoperative period were validated. There was no significant difference in the blood loss rates because arthrodesis was performed in a short segment in the analyzed studies. The short fixation was performed in a shorter operative time, as expected.No study has shown superior clinical outcomes. The short fixation had worse rates of kyphosis correction in the immediate postoperative period, and increased loss of correction in long-term follow-up, making the long fixation an effective option in the management of this type of fracture.

Long versus Short Segment Instrumentation in Osteoporotic Thoracolumbar Vertebral Fracture

“…However, these results were based on the observation of traumatic fracture in young patients and not in the osteoporotic population [ 20 ]. Moreover, according to our results, the analysis of kyphotic correction made by Assuncao Filho et al [ 21 ] indicated poorer corrections for SSS immediately after surgery and a greater loss of this correction in the long-term follow-up. In our comparative study, we did not find a worse loss of kyphotic correction over time; in fact, after 3 months from surgery, kyphotic deformity tended to remain stable over time.…”

Surgical treatment of unstable uncomplicated vertebral fractures

“…Среди всех проблем травматизма особое место занимают вопросы диагностики и лечения повреждений позвоночника [1,2]. Это связано с тенденцией возрастания удельного веса обсуждаемых повреждений [9]. Частота травм позвоночника составляет 10,5 на 100 тыс.…”

“…при рассматриваемых повреждениях не наблюдаются. Эти технологии в медицине относятся к прорывным направлениям и способствуют не только снизить инвалидность, но и значительно улучшить качества жизни больных [2,3,7,9,12].…”

“…Вопросы хирургического лечения этих повреждений далеки от решения, о чем свидетельствует многообразие рекомендуемых подходов. Не останавливаясь на описанные ранее в литературе методик оперативного лечения обсуждаемых повреждений, отметим, что многими исследователями декларируется необходимость широкого применения методики заднего транспедикуллярного спондилодеза [8,9]. Тем не менее, в этом вопросе нет единого мнения, чему свидетельствуют работы, посвященные переднему спондилодезу [5], а также дискуссии по поводу выполнения краткосегментного и длинносегментного транспедикуллярного спондилодеза [7,8].…”