Approach to junctional fractures in spine: A systematic review and meta-analysis

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Spine Surgery

Background:

• Management of thoracolumbar burst fractures lacks a consensus on optimal surgical techniques.
• Current surgical options include anterior, posterior, and combined anterior-posterior instrumentation.
• There is a critical need for comparative studies to evaluate the efficacy of these approaches.

Purpose of the Study:

• To critically evaluate and compare different surgical management approaches for thoracolumbar spine fractures.
• To identify the most effective treatment strategy for these complex injuries.
• To address the existing gap in comparative efficacy research.

Main Methods:

• A comprehensive literature search was conducted across 13 electronic databases from 2000 to August 2023.
• Included were 13 studies: nine non-randomized control trials (NRCTs) and four randomized control trials (RCTs).
• Risk of bias was assessed using the Newcastle-Ottawa scale for NRCTs and the ROB-b tool for RCTs.

Main Results:

• The posterior surgical approach was associated with longer operative times and greater blood loss compared to anterior or combined approaches.
• The posterior approach demonstrated immediate postoperative improvement in kyphotic correction, but this was followed by a loss of angle during follow-up.
• Significant heterogeneity in patient populations, fracture types, and surgical techniques across studies complicated definitive conclusions.

Conclusions:

• Both anterior and posterior surgical approaches for thoracolumbar fractures have distinct advantages and disadvantages.
• The current lack of consensus and standardized protocols necessitates further research.
• Establishing definitive guidelines for surgical decision-making in thoracolumbar spine fractures is crucial.