title: Combined anterior-posterior surgery versus posterior surgery for thoracolumbar burst fractures: a systematic review of the literature.
abstract: METHODS
  A systematic quantitative review of the literature.
  
  
  OBJECTIVE
  To compare combined anterior-posterior surgery versus posterior surgery for thoracolumbar fractures in order to identify better treatments.
  
  
  BACKGROUND
  Axial load of the anterior and middle column of the spine can lead to a burst fracture in the vertebral body. The management of thoracolumbar burst fractures remains controversial. The goals of operative treatment are fracture reduction, fixation and decompressing the neural canal. For this, different operative methods are developed, for instance, the posterior and the combined anterior-posterior approach. Recent systematic qualitative reviews comparing these methods are lacking.
  
  
  METHODS
  We conducted an electronic search of MEDLINE, EMBASE, LILACS and the Cochrane Central Register for Controlled Trials.
  
  
  RESULTS
  Five observational comparative studies and no randomized clinical trials comparing the combined anteriorposterior approach with the posterior approach were retrieved. The total enrollment of patients in these studies was 755 patients. The results were expressed as relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes with 95% confidence intervals (CI).
  
  
  CONCLUSIONS
  A small significantly higher kyphotic correction and improvement of vertebral height (sagittal index) observed for the combined anterior-posterior group is cancelled out by more blood loss, longer operation time, longer hospital stay, higher costs and a possible higher intra- and postoperative complication rate requiring re-operation and the possibility of a worsened Hannover spine score. The surgeons' choices regarding the operative approach are biased: worse cases tended to undergo the combined anterior-posterior approach.
authors.affiliation: Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: P Oprel
authors.forename: Wim E
authors.initials: WE
authors.lastname: Tuinebreijer
authors.forename: Peter
authors.initials: P
authors.lastname: Patka
authors.forename: Dennis
authors.initials: D
authors.lastname: den Hartog