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Meta-Analysis
. 2013 May 31;2013(5):CD009073.
doi: 10.1002/14651858.CD009073.pub2.

Pedicle screw fixation for traumatic fractures of the thoracic and lumbar spine

Li Ming Cheng  1 , Jian Jie Wang, Zhi Li Zeng, Rui Zhu, Yan Yu, Chunbo Li, Zhou Rui Wu
Affiliations
Meta-Analysis

Pedicle screw fixation for traumatic fractures of the thoracic and lumbar spine

Li Ming Cheng et al. Cochrane Database Syst Rev. .

Abstract

Background: Spine fractures are common. The treatment of traumatic fractures of the thoracic and lumbar spine remains controversial but surgery involving pedicle screw fixation has become a popular option.

Objectives: To assess the effects (benefits and harms) of pedicle screw fixation for traumatic fractures of the thoracic and lumbar spine.

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2011), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, 2011 Issue 1), MEDLINE (1948 to March 2011), EMBASE (1980 to 2011 Week 11), the Chinese Biomedical Database (CBM Database) (1978 to March 2011), the WHO International Clinical Trials Registry Platform (March 2011), reference lists of articles and conference proceedings.

Selection criteria: Randomised controlled trials (RCTs) and quasi-randomised controlled trials comparing pedicle screw fixation and other methods of surgical treatment, or different methods of pedicle screw fixation, for treating traumatic fractures of the thoracic and lumbar spine.

Data collection and analysis: Three review authors independently performed study selection, risk of bias assessment and data extraction. Limited meta-analysis was performed.

Main results: Pedicle screw fixation versus other methods of surgery that do not involve pedicle screw fixation was not looked at in any of the identified trials. Studies that were identified investigated different methods of pedicle fixation.Five randomised and three quasi-randomised controlled trials were included. All were at high or unclear risk of various biases, including selection, performance and detection bias. A total of 448 patients with thoracic and lumbar spine fractures were included in the review. Participants were restricted to individuals without neurological impairment in five trials. The mean ages of study populations of the eight trials ranged from 33 to 41 years, and participants had generally experienced traumatic injury. Mean follow-up for trial participants in the eight trials ranged from 28 to 72 months.Five comparisons were tested.Two trials compared short-segment instrumentation versus long-segment instrumentation. These studies found no significant differences between the two groups in self-reported function and quality of life at final follow-up. Aside from one participant, who sustained partial neurological deterioration that was resolved by further surgery (group not known), no neurological deterioration was noted in these trials.One trial comparing short-segment instrumentation with transpedicular bone grafting versus short-segment fixation alone found no significant difference between the two groups related to patient-perceived function and pain at final follow-up. All participants had normal findings on neurological examination at final follow-up.Two trials compared posterior instrumentation with fracture level screw incorporation ('including' group) versus posterior instrumentation alone ('bridging' group). Investigators reported no differences between the two groups in patient-reported function, quality of life, or pain at final follow-up. One trial confirmed that all participants had normal findings on neurological examination at final follow-up.One trial comparing monosegmental pedicle screw instrumentation versus short-segment pedicle instrumentation found no significant differences between the two groups in Oswestry Disability Index results or in pain scores at final follow-up. No neurological deterioration was reported.Three trials compared posterior instrumentation with fusion versus posterior instrumentation without fusion. Researchers found no differences between the two groups in function and quality of life or pain. No participants showed a decline in neurological status in any of the three trials, and no significant difference was reported between groups in the numbers whose status had improved at final follow-up. Two trials stated that patients in the fusion group frequently had donor site pain. Other reported complications included deep vein thrombosis and superficial infection.

Authors' conclusions: This review included only eight small trials and five different comparisons of methods of pedicle fixation in various participants while looking at a variety of outcomes at different time points. Overall, evidence is insufficient to inform the selection of different methods of pedicle screw fixation or the combined use of fusion. However, in the absence of robust evidence to support fusion, it is important to factor the risk of long-term donor site pain related to bone harvesting into the decision of whether to use this intervention. Further research involving high-quality randomised trials is needed.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Short‐segment instrumentation versus long‐segment instrumentation, Outcome 1 Low Back Outcome Score (0 to 75: best outcome) at average 29.6 months follow‐up.
1.2
1.2. Analysis
Comparison 1 Short‐segment instrumentation versus long‐segment instrumentation, Outcome 2 Radiological outcomes at final follow‐up.
1.3
1.3. Analysis
Comparison 1 Short‐segment instrumentation versus long‐segment instrumentation, Outcome 3 Peri‐operative outcomes.
1.4
1.4. Analysis
Comparison 1 Short‐segment instrumentation versus long‐segment instrumentation, Outcome 4 Length of hospital stay (days).
2.1
2.1. Analysis
Comparison 2 Short‐segment instrumentation with transpedicular grafting (TPG) versus short‐segment fixation alone (NTPG), Outcome 1 Self‐reported function and pain (Likert scale: 0 to 10: best) at 32 months.
2.2
2.2. Analysis
Comparison 2 Short‐segment instrumentation with transpedicular grafting (TPG) versus short‐segment fixation alone (NTPG), Outcome 2 Radiological outcomes at 32 months follow‐up.
2.3
2.3. Analysis
Comparison 2 Short‐segment instrumentation with transpedicular grafting (TPG) versus short‐segment fixation alone (NTPG), Outcome 3 Kyphosis correction loss > 10 degrees.
2.4
2.4. Analysis
Comparison 2 Short‐segment instrumentation with transpedicular grafting (TPG) versus short‐segment fixation alone (NTPG), Outcome 4 Peri‐operative outcomes.
2.5
2.5. Analysis
Comparison 2 Short‐segment instrumentation with transpedicular grafting (TPG) versus short‐segment fixation alone (NTPG), Outcome 5 Length of hospital stay (days).
3.1
3.1. Analysis
Comparison 3 Posterior pedicular fixation with fracture level screw incorporation (including) versus without incorporation (bridging), Outcome 1 Pain (VAS scale: 0 to 10: worst) at 37 months follow.
3.2
3.2. Analysis
Comparison 3 Posterior pedicular fixation with fracture level screw incorporation (including) versus without incorporation (bridging), Outcome 2 Postoperative complications.
3.3
3.3. Analysis
Comparison 3 Posterior pedicular fixation with fracture level screw incorporation (including) versus without incorporation (bridging), Outcome 3 Radiological outcomes at final follow‐up.
3.4
3.4. Analysis
Comparison 3 Posterior pedicular fixation with fracture level screw incorporation (including) versus without incorporation (bridging), Outcome 4 Peri‐operative outcomes.
3.5
3.5. Analysis
Comparison 3 Posterior pedicular fixation with fracture level screw incorporation (including) versus without incorporation (bridging), Outcome 5 Length of hospital stay (days).
4.1
4.1. Analysis
Comparison 4 Monosegmental transpedicular fixation (MSPI) versus short‐segment pedicle instrumentation (SSPI), Outcome 1 Low Back Outcome Score (0 to 75: best outcome) at average 27.8 months follow‐up.
4.2
4.2. Analysis
Comparison 4 Monosegmental transpedicular fixation (MSPI) versus short‐segment pedicle instrumentation (SSPI), Outcome 2 Oswestry Disability Index (0 to 100: worst disability) at average 27.8 months follow‐up.
4.3
4.3. Analysis
Comparison 4 Monosegmental transpedicular fixation (MSPI) versus short‐segment pedicle instrumentation (SSPI), Outcome 3 Pain (VAS scale: 0 to 10: worst) at 27.8 months follow up.
4.4
4.4. Analysis
Comparison 4 Monosegmental transpedicular fixation (MSPI) versus short‐segment pedicle instrumentation (SSPI), Outcome 4 Radiological outcomes at 27.8 months follow‐up.
4.5
4.5. Analysis
Comparison 4 Monosegmental transpedicular fixation (MSPI) versus short‐segment pedicle instrumentation (SSPI), Outcome 5 Peri‐operative outcomes.
5.1
5.1. Analysis
Comparison 5 Fusion versus non‐fusion, Outcome 1 Self‐reported function and quality of life scores at final follow‐up.
5.2
5.2. Analysis
Comparison 5 Fusion versus non‐fusion, Outcome 2 Neurological status at final follow‐up.
5.3
5.3. Analysis
Comparison 5 Fusion versus non‐fusion, Outcome 3 Pain (VAS scale: 0 to 10: worst) at 72 months follow up.
5.4
5.4. Analysis
Comparison 5 Fusion versus non‐fusion, Outcome 4 Postoperative complications.
5.5
5.5. Analysis
Comparison 5 Fusion versus non‐fusion, Outcome 5 Radiographic outcomes at final follow‐up.
5.6
5.6. Analysis
Comparison 5 Fusion versus non‐fusion, Outcome 6 Peri‐operative outcomes.
5.7
5.7. Analysis
Comparison 5 Fusion versus non‐fusion, Outcome 7 Length of hospital stay (days).
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Update of

  • doi: 10.1002/14651858.CD009073

References

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