Mono-segment versus short-segment pedicle instrumentation for treatment of one-level thoracolumbar burst fracture: a Meta analysis

English Keywords:Spinal fracture  Thoracolumbar  Burst  Pedicle instrumentation  Mono-segment  Short-segment  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To compare the clinical effect between mono-segment pedicle instrumentation(MSPI) and short-segment pedicle instrumentation(SSPI) in the treatment of one-level thoracolumbar burst fracture. Methods: By searching PubMed, Embase, Web of Science, Cochrane Library and China National Knowlage Infrastructure（CNKI） etc, the studies of MSPI versus SSPI for treatment of thoracolumbar burst fracture were collected. The key words were "mono-segment pedicle instrumentation", "MSPI" or "monosegmental pedicle instrumentation" and "burst fracture". Studies from the establishment of database to October 30, 2018 were retrieved, with a language restriction of Chinese or English. Comparative studies about the treatment of thoracolumbar burst fractures with mono-segment and short-segment internal fixation were included. The patients were older than 18 years old with more than one year follow-up. The risk of bias of the included studies was evaluated, Newcastle-Ottawa Scale(NOS) for retrospective cohort studies and Physiotherapy Evidence Database(PEDro) for randomized controlled studies were used. All data were analyzed by Stata 12.0 software. Weighted mean differnce(WMD) and its 95% confidence interval(95%CI) were calculated according to the heterogeneity between groups. Sensitivity analysis and subgroup analysis were performed to identify the heterogeneity sources. The outcomes included surgery related indexes(operation time, blood loss); visual analogue score(VAS), vertebral kyphosis angle and vertebral compression ratio at preoperation, postoperation and the end of follow-up. Results: Two randomized controlled trials and four cohort studies including 390 patients were included in the Meta analysis(190 patients for MSPI and 200 patients for SSPI). Quality evaluation indicated that all the included studies were high quality cohort studies(the NOS of 4 retrospective cohort studies ranged from 5 to 9, and the PEDro scores of 2 randomized controlled studies were 8). The operation time (WMD=-23.19, 95%CI: -44.63, -1.75) of the mono-segment fixation group was significantly lower than that of the short-segment fixation group(P=0.034), while the intraoperative blood loss was not significant(P=0.10). There was no significant difference between the two groups in the kyphosis angle, compression ratio or VAS score before operation (P>0.05), and there was no significant difference between the two groups in the compression ratio at postoperation and the end of follow-up(P>0.05). The vertebral kyphosis angle(WMD=0.67, 95%CI: -0.48, 1.83) and VAS (WMD=-0.39, 95%CI: -0.60, -0.18) were better in the mono-segment fixation group than in the short-segment fixation group at postoperation(P=0.001, P<0.0001). However, there was no significant difference between the two groups at the end of follow-up(P=0.875, P=0.523). The subgroup analysis of injured vertebral fixation method showed that compared with the trans-injured vertebra fixation group(WMD=-0.44, 95%CI: -1.02, 0.15), the across-injured vertebra fixation group(WMD=0.11, 95%CI: -0.28, 0.50) significantly improved the VAS at the end of follow-up(P=0.006). There was no published bias of included studies, evaluating by funnel graph and Egger′s test(P=0.055). Conclusions: In the treatment of one-level thoracolumbar burst fracture, MSPI has the advantages of less operation time, less postoperative pain in short-term and better recovery of kyphosis angle comparing with SSPI. The clinical efficacy of both is comparable at least for 1 year follow-up.