Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Abstract

Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.

Keywords: Burst; Fixation; Long-segment; Pedicle screws; Short-segment; Spine; Thoracolumbar.

Fig. 1. Flow diagram of the study selection.

Fig. 2. Number of patients in both groups. Pts, patients.

Fig. 3. Risk difference estimate for anterior vertebral height.

Fig. 4. Forest plot for standardized mean difference postoperative Cobb's angle.

Fig. 5. Risk difference estimate for final follow-up Cobb's angle.

Fig. 6. Standard mean difference estimate for final follow-up Cobb's angle.

Fig. 7. Risk difference estimate for final follow-up sagittal index.

Fig. 8. Standard mean difference estimate at final follow-up for sagittal index in six relevant studies.

Fig. 9. Standard mean difference estimate at final follow-up for Oswestry disability index in four relevant studies.

Fig. 10. Standard mean difference estimate at final follow-up for Denis pain scale in two relevant studies.

Fig. 11. Standard mean difference estimate at final follow-up for Deniswork scale in two relevant studies.

Fig. 12. Odd ratio estimate for final follow-up clinical scores.

Fig. 13. Risk ratio estimate for implant failure at final follow-up.