Meta-analysis Of Anterior Versus Posterior Surgery For Thoracolumbar Burst Fractures

Objective: To compare anterior surgery versus posterior surgery for thoracolumbar burst fractures in order to identify better treatments.Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases for relevant randomized controlled trials(RCTs) and comparative observational studies that compared anterior surgery versus posterior surgery for thoracolumbar burst fractures through October 2014.The quality of studies included was critically evaluated. The study design, participant characteristics, interventions, follow-up rate and period, and outcomes were abstracted after the assessment of methodological quality of the trials.Results: Seven studies were identified--2 RCTs and 5 observational comparative studies. 382 patients are enrolled.The posterior group’s kyphotic correction in postoperative(P<0.00001), end of follow-up(P<0.00001)was significantly higher than the anterior group.There is on significant different in neurological improvement(P=0.14), total postoperative complications(P=0.38) and postoperative instrumentation problem in all complications(P=0.41) between groups.The anterior group has a longer operative time( P=0.003),more mean volume blood loss(P<0.00001) and longer hospital stay(P<0.00001). The postoperative spinal canal encroachment level(P<0.00001) is higher in posterior group.Conclusions: For kyphotic correction and canal decompression,posterior approach could be a better choice,and it has less blood loss,short operation time and longer hospital stay. Differences of the postoperative complications and most items in SF-36 score system were not apparently significant between the two approaches. The evidence of our review is not powerful enough for it may be influenced by the limited sample size we collected.