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Posterior Thoracolumbar Instrumented Fusion for Burst Fractures

A Meta-analysis

Ituarte, Felipe, MD*; Wiegers, Nicholas W., BS*; Ruppar, Todd, PhD, RN; Goldstein, Christina, MD*; Nourbakhsh, Ali, MD

doi: 10.1097/BSD.0000000000000763

Study Design: This was a meta-analysis study.

Objective: To compare different posterior spine fixation methods for burst fracture fixation.

Summary of Background Data: This study was performed to elucidate if the current body of literature supports one posterior spinal fusion fixation method for burst fracture to minimize the rate of implant failure and progression of posttraumatic kyphosis.

Materials and Methods: An extensive electronic search was conducted using PubMed for pertinent articles. The articles were examined against the inclusion and exclusion criteria. Data pertaining to kyphosis angle, Frankel score, vertebral level, blood loss, operation time, hospital stay, postoperative bracing, instrument failure, complications, and follow-up were collected. A random effects model was chosen due to variation among the individual studies’ patient populations and surgical methods.

Results: A total of 23 publications were eventually deemed eligible according to the criteria and included into this study. The group with 2 levels above and 1 below with intermediate screws had the greatest maintenance of spine kyphosis and lowest implant failure at final follow-up (P<0.001). There was no difference between the periods of hospital stay (P=0.788) and blood loss (P=0.154) among different tiers.

Conclusions: A fixation method consisting of 2 levels above and 1 below with intermediate screws for the thoracolumbar burst fractures showed the highest correction of kyphosis angle both at immediate and final follow-up and also the lowest implant failure at final follow-up.

*Department of Orthopaedic Surgery, University of Missouri, Columbia, MO

Rush University College of Nursing, Chicago, IL

WellStar Atlanta Medical Center, Atlanta, GA

The authors declare no conflict of interest.

Reprints: Ali Nourbakhsh, MD, Spine Surgery Division, WellStar Atlanta Medical Center, 303 Parkway Drive NE, Atlanta, GA 30312 (e-mail:

Received July 9, 2018

Accepted November 26, 2018

© 2019 by Lippincott Williams & Wilkins, Inc.