Metaanalysis of treatment results in lower thoracic and lumbar spine burst fractures

Kostiantin Popsuishapka

Abstract


There are conservative and surgical (fusion at 360°, posterior and anterior) method of treatment for burst fractures of the low­er thoracic and lumbar spine. However, each has its limitations and open questions.

Objective: to identify trends in the use of various methods of treatment of burst vertebral fractures.

Methods: meta-analysis of publications in professional journals, Medline and PubMed databases for the period 2001–2015 years.

Results: found 124 scientific articles, 16 of which were selected, corresponding to II–III level of evidence. Total the results of treatment of 692 patients with burst fractures of the lower thoracic and lumbar spine are presented in these papers. A com­parative analysis of the results of conservative and surgical treatment, transpedicular fixation (TPF) of different lengths, proved the effectiveness of anterior fusion.

Conclusions: choice of treatment for burst fractures of the lower thoracic and lumbar spine depends on injury morphology, neurological status and general condition of the patient, the surgeon’s preferences and skills. In case of damage type A classification Magerl fragmen­tation of the vertebral body to 50 %, but with a intact posterior complex recommended conservative treatment. In case of damage of the AB type fragmentation of the vertebral body to 50 % with injuries posterior support complex and longitudinal liga­ment, spinal canal stenosis of 50 % short posterior TPF without anterior reconstruction can be used. Long TPF in this group of patients provides a more effective correction of distortion and reliable stabilization. Anterior decompression and fusion alone or in combination with short TPF effective in treating compli­cated and uncomplicated burst spine fractures.

Keywords


burst spinal fractures; the thoracic and lumbar spine; anterior and posterior spinal fusion; transpedicular fixation

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DOI: https://doi.org/10.15674/0030-598720164134-142

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