Fusion not necessary in addition to fixation of thoracolumbar burst fractures .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2018;6(9):15 J Neurosurg Spine. 2017 Nov;27(5):584-592Five randomized and quasi-randomized controlled trials were included in this meta-analysis comparing surgical and postoperative outcomes in internal fixation of thoracolumbar burst fractures with and without additional fusion. For surgical outcomes, fusion groups demonstrated significantly longer operative time and intraoperative blood loss. For postoperative outcomes, there were no significant differences observed between fusion and no fusion groups for functional scores, radiographic outcomes, or the incidence of fixation failure.
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Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Thoracolumbar burst fractures are common spinal fractures. While traditionally managed nonoperatively, there has been increasing use of fixation for these fractures over the past few decades. Arthrodesis - or fusion - can also be used alongside fixation, though the role of fusion, from an evidence-based standpoint, is still debated.
¿Cuál era la pregunta principal de la investigación?
Is there any significant difference in outcome after thoracolumbar burst fracture between internal fixation with and without additional fusion?
- Differences in clinical outcome scores between the fusion and no fusion groups were not significant, including a VAS function score (2 studies; MD 0.1 [95%CI -0.31, 0.51]; p=0.63) and the Low Back Outcome Score (4 studies; MD 4.03 [95%CI -4.97, 13.05; p=0.38)
- Differences significantly favoured no fusion over fusion for operative time (4 studies; MD -54.9min [95%CI -77.27, -32.65]; p<0.05) and in intraoperative blood loss (4 studies; MD -164.45mL [95%CI -236.64, -92.26]; p<0.05). The difference between groups was not significant for length of hospital stay (3 studies; MD 0.88 days [95%CO -0.42, 2.17]; p=0.18).
- Incidence of fixation failure did not significantly differ between the fusion (4.6%) and no fusion group (7.2%) (3 studies; OR 0.687 [95%CI 0.211-2.238]; p=0.53).
- No significant differences in segment mobility, correction of kyphosis, loss of correction of kyphosis, final kyphotic angle, or correction of vertebral height were observed between fusion and no fusion groups.
¿Qué es lo que más debo recordar?
In surgical management of thoracolumbar burst fractures, the addition of fusion to fixation did not result in any significantly different effect on clinical outcome, radiological outcome, or fixation failure rate when compared to fixation alone. Adjunct fusion was also associated with significantly longer operative time and greater intraoperative blood loss.
¿Cómo afectará esto al cuidado de mis pacientes?
The results of this meta-analysis suggest that routine fusion in addition to fixation may not be necessary in treatment of thoracolumbar burst fractures.
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