title: [Analysis of the Cochrane Review: Pedicle Screw Fixation for Traumatic Fractures of the Thoracic and Lumbar Spine. Cochrane Database Syst Rev. 2013;05:CD009073].
abstract: Traumatic fractures of the thoracic and lumbar spine are common causes of spine surgery. Pedicle screw fixation is usually chosen, using monosegmentar, short or long segment instrumentations, with or without bone graft. This review aims to evaluate the effect of transpedicular fixation in traumatic fractures of the thoracic and lumbar spine. A systematic search on controlled, randomized or quasi-randomized trials comparing different methods of surgical treatment of this fractures was performed, followed by a process of article selection, data extraction and bias assessment by 3 independent authors. Eight articles were included in a total of 5 comparisons, between different transpedicular fixation techniques. No significant differences on function or quality of life, neurologic status or limitation of motion were found. Only instrumentation with fracture level screw incorporation showed significant decrease of pain when compared with instrumentation alone. Several techniques resulted in significant improvements of different radiological parameters. Significantly, surgeries with smaller duration were associated with lesser blood loss. Bone graft use caused a significant raise in post-operative complications, namely donor site pain. So, this paper showed that significative improvements in radiological parameters do not associate with correspondent clinical benefits, and only instrumentation with level screw incorporation is associated with a clear benefit on pain. Moreover, the need for bone graft is questioned, since it leads to no clinic-radiological improvement with a raise of complications. However, a small number of controlled studies is available on this topic.
authors.affiliation: Serviço de Ortopedia. Centro Hospitalar São João. Porto. Departamento de Ciências de Informação e Decisão em Saúde. Centro de Investigação em Tecnologias e Serviços de Saúde. Faculdade de Medicina da Universidade do Porto. Porto.
authors.forename: Daniela
authors.initials: D
authors.lastname: Linhares
authors.affiliation: Serviço de Ortopedia. Centro Hospitalar São João. Porto. Serviço de Ortopedia. Hospital CUF. Porto. Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Neves
authors.affiliation: Serviço de Ortopedia. Centro Hospitalar São João. Porto. Serviço de Ortopedia. Hospital CUF. Porto. Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ribeiro da Silva
authors.affiliation: Departamento de Ciências de Informação e Decisão em Saúde. Centro de Investigação em Tecnologias e Serviços de Saúde. Faculdade de Medicina da Universidade do Porto. Porto. Unidade de Imunoalergologia. Hospital CUF. Porto.
authors.forename: João
authors.initials: J
authors.lastname: Almeida Fonseca
mesh_terms: D005592:Fracture Fixation / Q000295:instrumentation*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery*; D065289:Pedicle Screws; D016032:Randomized Controlled Trials as Topic; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery*