The Outcome Of Posterior Short-segment Fixation Combined With Bone Grafting In The Treatment Of Thoracolumbar Burst Fractures: A Meta Analysis

BackgroundAs posterior short-segment fixation has become the main surgical procedure to thoracolumbar burst fractures, there continues to be lots of controversies whether additional bone grafting are needed, especially when decided according to one’s experiment.Since more and more researches about fusion or non-fusion are reported in recent few years, a Meta analysis is quite necessary to reveal whether additional fusion brings better outcomes or not.ObjectivesTo evaluate the outcome of posterior short-segment pedicle screw fixation with or without additional bone grafting in the treatment of thoracolumbar burst fractures.MethodsThe randomized controlled trials that described both the clinical and radiological outcomes were searched on PubMed(1966-2014.12),ELSEVIER,Springerlink and Google Scholar. Data were extracted and evaluated by two individuals. The indicators we analysis mainly conclude:the operation time, blood loss, hospital stay, postoperative kyphotic angle, postoperative vertebral body hight, the latest follow-up neurologic status, the complications and the rate of failure. The quality and data analysis of these trials were assessed and calculated with the criteria and tools from The Cochrane Collaboration.ResultsA total of 4 eligible trials involving 198 patients were included(F:NF=l 00:98). The meta analysis revealed that it was reliable to treat the thoracolumbar fractures with posterior short-segment fixation,whereas there were significant differences neither in correcting local kyphotic angle and vertebral body height nor in preventing implant failure whether additional bone grating was given or not.Both groups achieved satisfactory clinical outcome, and the group without bone grafting specially had a advantage of eliminating the pain of donor site and significantly reducing operative time (p<0.0001) and blood loss (p=0.0003).ConclusionThis meta analysis of short-term results demonstrates that posterior short-segment fixation with bone grafting simultaneously is not a routine or necessary procedure in the treatment of thoracolumbar fractures and shows few advantage especially when LSC scoring≤6, but a longer time of more investigations are needed.