Pedicle screw fixation of thoracolumbar fractures: conventional short segment versus short segment with intermediate scr
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REVIEW ARTICLE
Pedicle screw fixation of thoracolumbar fractures: conventional short segment versus short segment with intermediate screws at the fracture level—a systematic review and meta‑analysis Carolijn Kapoen1 · Yang Liu2 · Frank W. Bloemers1 · Jaap Deunk1 Received: 4 April 2020 / Revised: 4 April 2020 / Accepted: 25 May 2020 © The Author(s) 2020
Abstract Objective Posterior short-segment fixation (4-screw construct = 4S) is the conventional surgical technique for thoracolumbar fractures. The effect of adding two intermediate pedicle screws at the fractured level (6-screw construct = 6S) is still a matter of debate. This review aims to compare the results between 4 and 6S pedicle screw fixation for thoracolumbar fractures. Methods A systematic review and meta-analysis were performed. The databases PubMed, Embase and Google Scholar were searched until January 2020. Inclusion criteria were studies comparing 4S and 6S techniques in patients with thoracolumbar fractures. Non-comparative studies and studies without full text were excluded. Cochrane risk of bias was assessed, and the GRADE approach was used to present the quality of evidence. Results Twenty-seven studies, of which 21 randomized controlled trials, with a total of 1890 patients (940 with 4S and 950 with 6S) were included. Meta-analysis showed that the 6S technique resulted in significantly lower pain scores, better shortterm and long-term Cobb angles, less loss of correction and less implant failures. However, longer operation time and more blood loss were seen with the 6S technique. Length of hospital stay, Oswestry Disability Index scores and infections did not differ significantly between the 6S and 4S techniques. Quality of the evidence according to GRADE was moderate to low. Conclusion In the treatment of thoracolumbar fractures, adding intermediate screws at the fracture level (6S) results in less post-operative pain, better radiological outcomes and less implant failure at the cost of a longer operation time and higher blood loss. Keywords Thoracolumbar fracture · Spine · Pedicle screw · Fracture level · Intermediate screw
Introduction Thoracolumbar fractures are the most common spinal injuries [1]. Although treatment remains controversial in some fracture types, posterior fixation is the most frequently used surgical technique to restore vertebral body height, correct kyphotic deformity, restore spinal stability and indirectly decompress the spinal canal [2]. The conventional surgical technique of posterior fixation is a short-segment 4-screw * Carolijn Kapoen [email protected] 1
Department of Trauma Surgery, VU University Medical Center, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
Department of Clinical Sciences Lund, Orthopedics, Lund University, Faculty of Medicine, 22185 Lund, Sweden
2
construct with pedicle screws one level above and one level below the fractured vertebra. However, several studies showed loss of reduction after short-segment pedicle screw fixation and undesirable rates of implant failure,
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