title: Fusion versus nonfusion for surgically treated thoracolumbar burst fractures: a meta-analysis.
abstract: BACKGROUND
  Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fusion could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fusion as a supplement to pedicle screw fixation for thoracolumbar burst fractures.
  
  
  RESULTS
  MEDLINE, OVID, Springer, and Google Scholar were searched for relevant randomized and quasi-randomized controlled trials that compared the clinical and radiological efficacy of fusion versus nonfusion 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. We generated pooled risk ratios or weighted mean differences across studies. Based on predefined inclusion criteria, 4 eligible trials with a total of 220 patients were included in this meta-analysis. The mean age of the patients was 35.1 years. 96.8% of the fractures were located at T12 to L1 level. Baseline characteristics were similar between the fusion and nonfusion groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The pooled data showed that the nonfusion group was associated with significantly reduced operative time (p<0.0001) and blood loss (p  = 0.0003).
  
  
  CONCLUSIONS
  The results of this meta-analysis suggested that fusion 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.
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, China.
authors.forename: Nai-Feng
authors.initials: NF
authors.lastname: Tian
authors.forename: Yao-Sen
authors.initials: YS
authors.lastname: Wu
authors.forename: Xiao-Lei
authors.initials: XL
authors.lastname: Zhang
authors.forename: Xin-Lei
authors.initials: XL
authors.lastname: Wu
authors.forename: Yong-Long
authors.initials: YL
authors.lastname: Chi
authors.forename: Fang-Min
authors.initials: FM
authors.lastname: Mao
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D005593:Fracture Fixation, Internal; D006760:Hospitalization; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D061646:Operative Time; D017594:Publication Bias; D016103:Spinal Fractures / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome