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Review
. 2023 Jun 12:10:1125665.
doi: 10.3389/fsurg.2023.1125665. eCollection 2023.

Comparison of anterior and posterior approaches in Treating odontoid fractures: a meta-analysis and systematic review

Xianguo Bao  1 , Yingjun Chen  1 , Chen Guo  2 , Shuai Xu  2
Affiliations
Review

Comparison of anterior and posterior approaches in Treating odontoid fractures: a meta-analysis and systematic review

Xianguo Bao et al. Front Surg. .

Abstract

Background: Odontoid fractures account for 15%-20% of cervical injuries. Although the operation methods vary in different types, the superiority of overall outcomes of the anterior approach (AA) and posterior approach (PA) in treating odontoid fractures still remains controversial. Thus, a meta-analysis was performed comparing AA and PA for these fractures.

Methods: The relevant studies were searched in PubMed/MEDLINE, Cochrane Library, EMBASE, China Biological Medicine (CBM), and Wanfang Database from the onset of conception to June 2022. Prospective or retrospective comparative studies on AA and PA for odontoid fractures were screened, referring to fusion rates (primary outcomes), complications, and postoperative mortality rates. A meta-analysis of the primary outcomes and a systematic review of other outcomes were performed; the procedure was conducted with Review Manager 5.3.

Results: Twelve articles comrising 452 patients were included, and all publications were retrospective cohort studies. The average postoperative fusion rate was 77.5 ± 17.9% and 91.4 ± 13.5% in AA and PA, respectively, with statistical significance [OR = 0.42 (0.22, 0.80), P = 0.009]. Subgroup analysis showed a difference in fusion rates between AA and PA in the elderly group [OR = 0.16 (0.05, 0.49), P = 0.001]. Five articles referred to postoperative mortality, and the mortality rates of AA (5.0%) and PA (2.3%) showed no statistical difference (P = 0.148). Nine studies referred to complications, with a rate of 9.7%. The incidence of complications in AA and PA groups was comparable (P = 0.338), and the incidence of nonfusion and complications was irrelevant. The prevalent cause of death was myocardial infarction. The time and segmental movement retention of AA were possibly superior to those of PA.

Conclusion: AA may be superior in regard to operation time and motion retention. There was no difference in complications and mortality rates between the two approaches. The posterior approach would be preferred in consideration of the fusion rate.

Keywords: anterior approach; complications; fusion rate; meta-analysis; odontoid fracture; posterior approach.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer, NX, declared a shared parent affiliation with authors SX and CG to the handling editor at the time of review.

Figures

Figure 1
Figure 1
Selection process for meta-analysis of the studies.
Figure 2
Figure 2
Funnel plot of the postoperative fusion rates of included studies.
Figure 3
Figure 3
Forest plot of the meta-analysis of fusion rates of AA and PA.
Figure 4
Figure 4
Forest plot of the meta-analysis of postoperative fusion rates in the elderly group.
See this image and copyright information in PMC

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