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Thoracolumbar Burst Fracture: McCormack Load-sharing Classification: Systematic Review and Single-arm Meta-analysis.
Ériko Gonçalves Filgueira1,2, Aline Mizusaki Imoto3, Helbert Eustáquio Cardoso da Silva3
1Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil.
Spine
|December 4, 2020
Summary
The load-sharing classification (LSC) reliably guides surgical treatment for thoracolumbar burst fractures (TBF). Scores up to 6 indicate posterior instrumentation is sufficient, while higher scores suggest low risk for complications with this approach.
Area of Science:
- Orthopedic surgery
- Spinal surgery
- Traumatology
Background:
- The load-sharing classification (LSC) is a tool used to guide surgical decisions for thoracolumbar burst fractures (TBF).
- Previous reviews have not evaluated the efficacy of LSC in guiding surgical treatment for TBF.
Purpose of the Study:
- To determine the reliability of the load-sharing classification (LSC) in predicting the optimal surgical approach for thoracolumbar burst fractures (TBF).
Main Methods:
- A systematic review and single-arm meta-analysis of randomized clinical trials.
- Searched EMBASE, PubMed, Cochrane, SCOPUS, Web of Science, LILACS, and gray literature.
- Included studies on TBF patients undergoing posterior surgical treatment, analyzed LSC, loss of segmental kyphosis, and implant failure (IF).
Main Results:
- Nine studies were included from 189 references.
- LSC scores up to 6 reliably indicated that only posterior instrumentation was necessary, with no loss of kyphosis or implant failure.
- For LSC scores >6, posterior fixation alone resulted in a low incidence of implant failure (2.5%) and loss of kyphosis correction (5%), with 6% overall postoperative problems.
Conclusions:
- LSC scores up to 6 are highly reliable, necessitating only posterior instrumentation.
- For LSC scores >6, posterior fixation alone presents a low risk of implant breakage and loss of kyphosis correction.
- Additional factors should be considered when determining the best surgical approach for TBF with LSC scores >6.
