Abstract
Objectives: To conduct a systematic review and single-arm meta-analysis to evaluate and compare the efficacy and safety of anterior, combined approaches, and short-segment pedicle screw fixation (PSF) without fusion in patients with neurologically intact thoracolumbar burst fractures (TLBF).
Methods: A systematic review following PRISMA guidelines was conducted. Inclusion criteria comprised articles published between 2004 and 2023, full-text availability in English, burst fractures without spinal cord or nerve root injuries at admission, short-segment PSF without fusion, anterior or combined fusion methods, patients aged 18 or older, and a minimum 12-month follow-up.
Meta-analysis was carried out using Comprehensive Meta-Analysis software. Using a single-arm meta-analysis method, pooled indicators of short- and long-term outcomes for each studied group were determined. The obtained data were then compared using simple comparison.
Results: The pooled mean Cobb angle at admission for the anterior, combined, and PSF groups was 14.2° (95% CI, 9.7–18.7), 13.2° (95% CI, 10.8–15.7), and 17.1° (95% CI, 15.1–19.1), respectively. Surgery achieved similar levels of kyphosis correction across all groups, but only the PSF group experienced significant correction loss after discharge (SMD = -0.582 [95% CI, -0.810, -0.354]), amounting to 3.7°. The anterior vertebral body compression rate at admission was 54.4% (95% CI, 45.7-63.0) in the combined group and 37.8% (95% CI, 33.7-41.9) in the PSF group.
Operative time, blood loss, and hospitalization duration were lowest in the percutaneous PSF group, with means of 96.5 minutes (95% CI, 82.4–110.6), 83.8 ml (95% CI, 71.7–95.9), and 6.6 days (95% CI, 4.7–8.5), respectively. The anterior approach showed a lower incidence of deep wound infections and implant-related complications. The pooled complication rates or the combined and PSF groups were 6.5% (95% CI, 2.7–14.5) and 5.6% (95% CI, 4.3–7.3), respectively.
The pooled Oswestry Disability Index (ODI) scores were 17.6 (95% CI, 11.8–23.3) for the anterior group, 15.4 (95% CI, 11.5–19.3) for the combined group, and 13.4 (95% CI, 10.4–16.3) for the PSF group.
Conclusions: For patients with neurologically intact TLBF with a kyphotic angle of less than 19.10 and an anterior vertebral body compression rate of less than 41.9%, anterior fusion can be avoided in favor of short-segment PSF without fusion. When determining the surgical approach, the surgeon should weigh the moderate advantage of anterior fusion in maintaining postoperative correction of kyphotic deformity against its significantly greater surgical trauma. Anterior and combined fusion have not demonstrated advantages over the posterior approach in the ODI during long-term outcomes assessment.