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.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
4/4
Introduction
4/4
Accessing Data
3/4
Analysing Data
4/4
Results
4/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
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.
Quelle était la principale question de recherche ?
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.
De quoi dois-je me souvenir en priorité ?
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.
Comment cela affectera-t-il les soins prodigués à mes patients ?
The results of this meta-analysis suggest that routine fusion in addition to fixation may not be necessary in treatment of thoracolumbar burst fractures.
AVIS DE NON-RESPONSABILITÉ
Le contenu de cette page est fourni à titre d'information uniquement et n'est pas destiné à remplacer un avis médical, un diagnostic ou un traitement professionnel. Si vous avez besoin d'un traitement médical, demandez toujours l'avis de votre médecin ou rendez-vous au service des urgences le plus proche. Les opinions, croyances et points de vue exprimés par les individus sur le contenu de cette page ne reflètent pas les opinions, croyances et points de vue d'OrthoEvidence.
0 de 4 articles mensuels GRATUITS débloqués
