Short-Segment Fixation in the Management of Thoracolumbar Burst Fractures - A Meta -analysis.

Introduction: Short- segment fixation is being increasingly used to minimiz e the number of fixation levels in thoracolumbar burst fractures (TLBFs). This study aims to analyze the radiological, functional, and neurological outcomes of short-segment fixation in TLBF.

Materials and methods: A meta-analysis was conducted through a web search on PubMed with the following keywords; thoracolumbar injury, burst fracture, and short- segment fixation. Scientific papers written in English from January 2001 to April 2024 were screened. PubMed search with the keywords revealed 183 articles which were thoroughly reviewed by all the authors. Of these, 11 studies satisfying the inclusion criteria describing short- segment fixation in TLBF s were included in this study. The minimum follow-up duration in each study was 12 months. The appropriate meta-analysis was carried out, and the forest plot for a single group which accounts for interstudy variation and provides a more conservative effect than the fixed effect model. Potential sources of heterogeneity were assessed using the standard chi-square test. In addition, the statistic I2 was used to investigate heterogeneity by examining the extent of inconsistency across the study results. A sensitivity analysis was carried out to assess the robustness of the results of the meta-analysis. Where heterogeneity was present between the studies, differences in study design were examined. All analyses were performed using online free meta-analysis software (https://metaanalysisonline.com).

Results: The results of this meta-analysis suggested that studies with an added intermediate screw at the level of fractured vertebra showed a better radiological appearance at the final follow- up as compared to traditional short-segment instrumentation. However, clinical outcomes showed no significant difference. A post-surgery neurological improvement was noted in all the studies except those with a complete pre-operative neurological deficit.

Conclusion: Short-segment instrumentation with intermediate screw fixation is a safe and effective method with excellent radiological and clinical outcomes with very low rates of failure while treating unstable TLBFs, where as traditional short-segment posterior fixation can lead to progressive loss of kyphosis correction with higher implant failure rate in patients with unstable fractures.