Percutaneous pedicle screw fixation versus mini-open Wiltse approach pedicle screw fixation in single level thoracolumbar fracture: a Meta-analysis

English Keywords:Thoracolumbar fractures  Percutaneous approach  Mini-open Wiltse approach  Pedicle screw fixation  Meta-analyses

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy of percutaneous pedicle screw fixation(PPSF) and mini-open Wiltse approach pedicle screw fixation(MWPSF) in the treatment of single level thoracolumbar fractures, and to provide evidence for clinical procedure. Methods: Databases including PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang Database were searched from their establishment to March 2020. Clinical controlled trials that compared PPSF and MWPSF for thoracolumbar fracture were identified. Studies included contained at least two of the following indicators: operation time, intraoperative blood loss, intraoperative radiation exposure, postoperative visual analog score(VAS), postoperative Cobb angle, postoperative VBH, postoperative ODI, and surgical complications. Meta-analyses were performed by using the RevMan 5.2 software. Results: There were 17 studies(3 randomized controlled trial, 14 cohort studies) involving 1057 patients. Among them, 519 patients underwent PPSF and 538 patients underwent MWPSF. The results of meta-analyses showed that: MWPSF had less operative time[SMD=17.87, 95%CI(11.60, 24.15), P＜0.05], much less intraoperative radiation exposure time[SMD=4.96, 95%CI(4.29, 5.63), P＜0.05]. At final follow-up, MWPSF had higher Cobb angle correction[SMD=-7.56, 95%CI(-10.61, -4.52), P＜0.01], lower Cobb angle correction loss[SMD=1.76, 95%CI(0.41, 3.11), P=0.01] and VBH correction loss[SMD=0.90，95%CI(0.30, 1.51), P＜0.05]; PPSF had much less intraoperative blood loss[SMD=-62.01, 95%CI(-78.84, -45.18), P＜0.05], and lower VAS at one week follow-up[SMD=-0.49, 95%CI(-0.87, -0.11), P=0.01]. There was no statistical difference of postoperative VAS, VBH, ODI, operative complication at final follow-up between two groups(P＞0.05). Conclusions: Both PPSF and MWPSF achieve satisfactory and safe clinical outcomes for single level thoracolumbar fracture. Compared to MWPSF, PPSF has less intraoperative blood loss and iatrogenic trauma, and can reduce early postoperative pain. However, PPSF has longer operative time, more iatrogenic radiation and less orthotic ability of kyphosis.