Pedicle screw fixation for traumatic fractures of the thoracic and lumbar spine

• Published in: Cochrane database of systematic reviews 2013-05 (5), p.CD009073-CD009073
• Main Authors: Cheng, Li Ming, Wang, Jian Jie, Zeng, Zhi Li, Zhu, Rui, Yu, Yan, Li, Chunbo, Wu, Zhou Rui
• Format: Article
• Language: English
• Subjects: Bone Screws; Fracture Fixation - instrumentation; Fracture Fixation - methods; Humans; Lumbar Vertebrae - injuries; Quality of Life; Randomized Controlled Trials as Topic; Recovery of Function; Spinal Fractures - surgery; Spinal Fusion - methods; Thoracic Vertebrae - injuries
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD009073.pub2

Spine fractures are common. The treatment of traumatic fractures of the thoracic and lumbar spine remains controversial but surgery involving pedicle screw fixation has become a popular option. To assess the effects (benefits and harms) of pedicle screw fixation for traumatic fractures of the thoracic and lumbar spine. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2011), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, 2011 Issue 1), MEDLINE (1948 to March 2011), EMBASE (1980 to 2011 Week 11), the Chinese Biomedical Database (CBM Database) (1978 to March 2011), the WHO International Clinical Trials Registry Platform (March 2011), reference lists of articles and conference proceedings. Randomised controlled trials (RCTs) and quasi-randomised controlled trials comparing pedicle screw fixation and other methods of surgical treatment, or different methods of pedicle screw fixation, for treating traumatic fractures of the thoracic and lumbar spine. Three review authors independently performed study selection, risk of bias assessment and data extraction. Limited meta-analysis was performed. Pedicle screw fixation versus other methods of surgery that do not involve pedicle screw fixation was not looked at in any of the identified trials. Studies that were identified investigated different methods of pedicle fixation.Five randomised and three quasi-randomised controlled trials were included. All were at high or unclear risk of various biases, including selection, performance and detection bias. A total of 448 patients with thoracic and lumbar spine fractures were included in the review. Participants were restricted to individuals without neurological impairment in five trials. The mean ages of study populations of the eight trials ranged from 33 to 41 years, and participants had generally experienced traumatic injury. Mean follow-up for trial participants in the eight trials ranged from 28 to 72 months.Five comparisons were tested.Two trials compared short-segment instrumentation versus long-segment instrumentation. These studies found no significant differences between the two groups in self-reported function and quality of life at final follow-up. Aside from one participant, who sustained partial neurological deterioration that was resolved by further surgery (group not known), no neurological deterioration was noted in these trials.One trial comparing short-segment instrumentation with