Efficacy and safety of short segment pedicle screw fixation in patients with neurologically intact burst fractures of the lower thoracic and lumbar spine: a meta-analysis of studies published over the last 20 years

Abstract

Objective. To conduct a systematic review and meta-analysis of studies on the surgical treatment of patients with uncomplicated burst fractures of the lower thoracic and lumbar spine and to determine the effectiveness and safety of short transpedicular fixation (TPF) in this patient group. Material and Methods. The study included articles with the following criteria: publication date from January 1, 2004, to December 31, 2023; patient sample descriptions involving uncomplicated burst fractures from T10 to L5; TPF involving one segment adjacent to the fractured vertebra in both cranial and caudal directions without spinal fusion; descriptions of treatment outcomes or complications; and an average follow-up period of at least 12 months. Meta-analysis was conducted using the Comprehensive Meta-Analysis software, version 2.2.064. Depending on the level of heterogeneity (I² test), either a fixed-effects or random-effects model was applied. Begg’s or Egger’s test was used to assess publication bias, and any bias present was corrected using the trim-and-fill method. Results. The application of TPF resulted in a significant reduction in the overall Cobb angle by 5.9 degrees in the percutaneous group and by 7.6 degrees when using a midline approach. Regarding AVBCR (anterior vertebral body compression ratio), a reduction of 24.0 % and 24.8 % was observed in both groups, respectively. The overall complication rates were as follows: superficial infection, 2.2 %; deep infection, 2.0 %; and implant-associated complications, 5.6 %. No patient developed a neurological deficit. The levels of work adaptation W1 and W2 on the Denis scale were achieved in 70.9 % of patients. The overall quality of life, as measured by the Oswestry Disability Index, averaged 13.4 %. Conclusions. Short transpedicular fixation without additional spinal fusion or laminectomy appears to be an effective and safe method for treating burst fractures of the lower thoracic and lumbar spine without neurological deficits. This method allows for regression of kyphotic deformity in the long-term post-injury period by at least 5.9 degrees and restoration of anterior vertebral height by 24 %. The approach demonstrated relatively low overall postoperative complication rates. More than 90 % of patients were able to return to full-time work, either in their previous position or with reduced physical demands.

Keywords

• transpedicular fixation
• uncomplicated burst fractures
• lower thoracic and lumbar spine
• meta-analysis