title: Comparison of Anterior Versus Posterior Approach in the Treatment of Thoracolumbar Fractures: A Systematic Review.
abstract: Despite extensive research on thoracolumbar fractures, controversy still exists about which approach is the most appropriate. Lack of evidence-based practice may result in patients being treated inappropriately. The objective of study was to perform a systematic review of the effectiveness of the anterior and posterior approaches in the treatment of thoracolumbar fractures. We conducted searches of PubMed and the Cochrane Library, searching for relevant trials up to August 2013 that compared anterior and posterior for the treatment of thoracolumbar fractures. The key words "anterior," "posterior," "thoracolumbar fracture," "CCT," and "RCT" were used. We assessed all included literature by using the Cochrane handbook (version 5.1). The results were expressed as the mean difference for continuous outcomes and risk difference for dichotomous outcomes, with a 95% confidence interval, using RevMan version 5.2. There were 3 randomized controlled trials and 11 clinical controlled trials included. The meta-analysis showed no significant difference between groups regarding Cobb angle, the Frankel scale, ASIA/JOA motor score, complications, and number of patients returning to work. Compared with the anterior approach, the posterior approach demonstrated superior canal decompression. In the burst fracture subgroup, operative times were significantly shorter and perioperative blood loss was less in the posterior approach group. The posterior approach is more effective for canal decompression, operative times, and perioperative blood loss. However, because of the lack of randomized controlled trials, and because of large sample size studies, heterogeneity was significant between reports. The optimal treatment for thoracolumbar fractures requires further study.
authors.affiliation: 1 Nanjing Medical University, Nanjing, China.
authors.forename: Qicong
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: 2 Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.|3 Department of Orthopedic Surgery, The Third People's Hospital, Yancheng, China.
authors.forename: Fengchao
authors.initials: F
authors.lastname: Shi
authors.affiliation: 4 Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Weihua
authors.initials: W
authors.lastname: Cai
authors.affiliation: 1 Nanjing Medical University, Nanjing, China.
authors.forename: Jianling
authors.initials: J
authors.lastname: Bai
authors.affiliation: 4 Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Fan
authors.affiliation: 2 Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Huilin
authors.initials: H
authors.lastname: Yang
mesh_terms: D019299:Decompression, Surgical; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery*; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery*
keywords: Anterior; Posterior; Systematic review; Thoracolumbar fracture