SPINE
Is fusion necessary for thoracolumbar burst fracture treated with spinal fixation? A systematic review and meta-analysis
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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報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
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Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
Is there any significant difference in outcome after thoracolumbar burst fracture between internal fixation with and without additional fusion?
重要な知見は？
- 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.
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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