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Pedicle screw fixation of thoracolumbar fractures : conventional short segment versus short segment with intermediate screws at the fracture level—a systematic review and meta-analysis

Kapoen, Carolijn ; Liu, Yang LU ; Bloemers, Frank W. and Deunk, Jaap (2020) In European Spine Journal
Abstract

Objective: Posterior short-segment fixation (4-screw construct = 4S) is the conventional surgical technique for thoracolumbar fractures. The effect of adding two intermediate pedicle screws at the fractured level (6-screw construct = 6S) is still a matter of debate. This review aims to compare the results between 4 and 6S pedicle screw fixation for thoracolumbar fractures. Methods: A systematic review and meta-analysis were performed. The databases PubMed, Embase and Google Scholar were searched until January 2020. Inclusion criteria were studies comparing 4S and 6S techniques in patients with thoracolumbar fractures. Non-comparative studies and studies without full text were excluded. Cochrane risk of bias was assessed, and the GRADE... (More)

Objective: Posterior short-segment fixation (4-screw construct = 4S) is the conventional surgical technique for thoracolumbar fractures. The effect of adding two intermediate pedicle screws at the fractured level (6-screw construct = 6S) is still a matter of debate. This review aims to compare the results between 4 and 6S pedicle screw fixation for thoracolumbar fractures. Methods: A systematic review and meta-analysis were performed. The databases PubMed, Embase and Google Scholar were searched until January 2020. Inclusion criteria were studies comparing 4S and 6S techniques in patients with thoracolumbar fractures. Non-comparative studies and studies without full text were excluded. Cochrane risk of bias was assessed, and the GRADE approach was used to present the quality of evidence. Results: Twenty-seven studies, of which 21 randomized controlled trials, with a total of 1890 patients (940 with 4S and 950 with 6S) were included. Meta-analysis showed that the 6S technique resulted in significantly lower pain scores, better short-term and long-term Cobb angles, less loss of correction and less implant failures. However, longer operation time and more blood loss were seen with the 6S technique. Length of hospital stay, Oswestry Disability Index scores and infections did not differ significantly between the 6S and 4S techniques. Quality of the evidence according to GRADE was moderate to low. Conclusion: In the treatment of thoracolumbar fractures, adding intermediate screws at the fracture level (6S) results in less post-operative pain, better radiological outcomes and less implant failure at the cost of a longer operation time and higher blood loss.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Fracture level, Intermediate screw, Pedicle screw, Spine, Thoracolumbar fracture
in
European Spine Journal
publisher
Springer
external identifiers
  • pmid:32529525
  • scopus:85086406305
ISSN
0940-6719
DOI
10.1007/s00586-020-06479-4
language
English
LU publication?
yes
id
e7db0018-bd3f-4062-a210-7e4f3a3b33d1
date added to LUP
2020-07-08 12:58:50
date last changed
2020-07-09 01:59:10
@article{e7db0018-bd3f-4062-a210-7e4f3a3b33d1,
  abstract     = {<p>Objective: Posterior short-segment fixation (4-screw construct = 4S) is the conventional surgical technique for thoracolumbar fractures. The effect of adding two intermediate pedicle screws at the fractured level (6-screw construct = 6S) is still a matter of debate. This review aims to compare the results between 4 and 6S pedicle screw fixation for thoracolumbar fractures. Methods: A systematic review and meta-analysis were performed. The databases PubMed, Embase and Google Scholar were searched until January 2020. Inclusion criteria were studies comparing 4S and 6S techniques in patients with thoracolumbar fractures. Non-comparative studies and studies without full text were excluded. Cochrane risk of bias was assessed, and the GRADE approach was used to present the quality of evidence. Results: Twenty-seven studies, of which 21 randomized controlled trials, with a total of 1890 patients (940 with 4S and 950 with 6S) were included. Meta-analysis showed that the 6S technique resulted in significantly lower pain scores, better short-term and long-term Cobb angles, less loss of correction and less implant failures. However, longer operation time and more blood loss were seen with the 6S technique. Length of hospital stay, Oswestry Disability Index scores and infections did not differ significantly between the 6S and 4S techniques. Quality of the evidence according to GRADE was moderate to low. Conclusion: In the treatment of thoracolumbar fractures, adding intermediate screws at the fracture level (6S) results in less post-operative pain, better radiological outcomes and less implant failure at the cost of a longer operation time and higher blood loss.</p>},
  author       = {Kapoen, Carolijn and Liu, Yang and Bloemers, Frank W. and Deunk, Jaap},
  issn         = {0940-6719},
  language     = {eng},
  publisher    = {Springer},
  series       = {European Spine Journal},
  title        = {Pedicle screw fixation of thoracolumbar fractures : conventional short segment versus short segment with intermediate screws at the fracture level—a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1007/s00586-020-06479-4},
  doi          = {10.1007/s00586-020-06479-4},
  year         = {2020},
}