1
|
Lanter L, Rutsch N, Kreuzer S, Albers CE, Obid P, Henssler J, Torbahn G, Müller M, Bigdon SF. Impact of different surgical and non-surgical interventions on health-related quality of life after thoracolumbar burst fractures without neurological deficit: protocol for a comprehensive systematic review with network meta-analysis. BMJ Open 2023; 13:e078972. [PMID: 38114286 DOI: 10.1136/bmjopen-2023-078972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION There is no international consensus on how to treat thoracolumbar burst fractures (TLBFs) without neurological deficits. The planned systematic review with network meta-analyses (NMA) aims to compare the effects on treatment outcomes, focusing on midterm health-related quality of life (HRQoL). METHODS AND ANALYSIS We will conduct a comprehensive and systematic literature search, identifying studies comparing two or more treatment modalities. We will search MEDLINE, EMBASE, Google Scholar, Scopus and Web of Science from January 2000 until July 2023 for publications. We will include (randomised and non-randomised) controlled clinical trials assessing surgical and non-surgical treatment methods for adults with TLBF. Screening of references, data extraction and risk of bias (RoB) assessment will be done independently by two reviewers. We will extract relevant studies, participants and intervention characteristics. The RoB will be assessed using the revised Cochrane RoB V.2.0 tool for randomised trials and the Newcastle-Ottawa Scale for controlled trials. The OR for dichotomous data and standardised mean differences for continuous data will be presented with their respective 95% CIs. We will conduct a random-effects NMA to assess the treatments and determine the superiority of the therapeutic approaches. Our primary outcomes will be midterm (6 months to 2 years after injury) overall HRQoL and pain. Secondary outcomes will include radiological or clinical findings. We will present network graphs, forest plots and relative rankings on plotted rankograms corresponding to the treatment rank probabilities. The ranking results will be represented by the area under the cumulative ranking curve. Analyses will be performed in Stata V.16.1 and R. The quality of the evidence will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluations framework. ETHICS AND DISSEMINATION Ethical approval is not required. The research will be published in a peer-reviewed journal.
Collapse
Affiliation(s)
- Lea Lanter
- Department of Orthopedic Surgery and Traumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Niklas Rutsch
- Department of Orthopedic Surgery and Traumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Sebastian Kreuzer
- Department of Orthopedic Surgery and Traumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Christoph Emanuel Albers
- Department of Orthopedic Surgery and Traumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Peter Obid
- Freiburg University Hospital, Freiburg im Breisgau, Germany
| | - Jonathan Henssler
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriel Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universitat Erlangen-Nurnberg Medizinische Fakultat, Nürnberg, Germany
| | - Martin Müller
- Department of Emergency Medicine, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Sebastian Frederick Bigdon
- Department of Orthopedic Surgery and Traumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| |
Collapse
|
2
|
Mugge L, Dang DD, Awan O, Vaughan M, Mui W, Brewer C, Dominick C, Hamilton J. Advantages of Short-Segment Fusion in the Surgical Management of Thoracolumbar Traumatic Fractures: A Case Series and Review of the Literature. Cureus 2023; 15:e39535. [PMID: 37366461 PMCID: PMC10290893 DOI: 10.7759/cureus.39535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Spine trauma is a common pathology that frequently requires neurosurgical intervention. Few studies have examined short-segment, 360-degree stabilization of traumatic thoracolumbar fractures. METHODS A retrospective review was completed of adult and pediatric patients who underwent surgical correction for thoracolumbar fractures between December 2011 and December 2021. RESULTS Forty patients met the inclusion criteria. The majority of patients presented with an American Spinal Injury Association (ASIA) score of D (n = 11) or E (n = 21). The most common level of injury was L1 (n = 20). The average length of stay was 11.7 days. Postoperatively, two patients had pulmonary emboli or deep venous thrombosis, and two had surgical site infections. Most patients were discharged to home (n = 21) or acute rehab (n = 14). The fusion rate at six months was 97.5%. Neurologically, all patients regained ambulation by >18 months follow-up. For the ASIA scale, most had a score of D (n = 4) or E (n = 32) at six months. The same trend was observed with the Frankel score, where most patients had either D (n = 5) or E (n = 31), improving to only two having a score of D at >18 months. CONCLUSIONS Corpectomy followed by posterior fusion has a number of biomechanical benefits. This construct permits circumferential decompression, larger surface area for fusion, improved reconstitution of vertebral body height, reduced kyphosis, and an overall shorter segment. This results in fewer levels needing to be fused while enabling the greatest changes of successful fusion.
Collapse
Affiliation(s)
- Luke Mugge
- Neurological Surgery, Inova Neuroscience and Spine Institute, Falls Church, USA
| | - Danielle D Dang
- Neurological Surgery, Inova Fairfax Medical Campus, Falls Church, USA
| | - Omar Awan
- Neurological Surgery, Inova Fairfax Medical Campus, Falls Church, USA
| | - Megan Vaughan
- Neurosurgery, Inova Neuroscience and Spine Institute, Falls Church, USA
| | - Wenli Mui
- Neurosurgery, Inova Neuroscience and Spine Institute, Falls Church, USA
| | - Cristie Brewer
- Neurosurgery, Inova Neuroscience and Spine Institute, Falls Church, USA
| | - Conner Dominick
- Neurological Surgery, Inova Neuroscience and Spine Institute, Falls Church, USA
| | - John Hamilton
- Neurological Surgery, Inova Neuroscience and Spine Institute, Falls Church, USA
| |
Collapse
|
3
|
Hou J, Ren D, Chen Y, Geng L, Yao S, Wu H, Wang P. Effectiveness of the Endplate Reduction Technique Combined With Bone Grafting for the Treatment of Thoracolumbar Fractures by Using Posterior Short-Segment Fixation. Neurospine 2023; 20:353-364. [PMID: 37016884 PMCID: PMC10080432 DOI: 10.14245/ns.2244980.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/09/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: This study aimed to examine the effect of the endplate reduction (EPR) technique combined with bone grafting for treating thoracolumbar burst fractures using posterior short-segmental fixation.Methods: Patients with thoracolumbar fractures admitted between January 2018 and October 2021 were retrospectively analyzed, and those meeting the criteria were assigned to the EPR group and the intermediate screws (IS) group. The vertebral wedge angle (VWA), Cobb angle (CA), anterior vertebral body height (AVBH), middle vertebral body height (MVBH), upper endplate line (UEPL), upper intervertebral angle (UIVA), and upper intervertebral disc height (UIDH) indices were examined and compared preoperatively, first day postoperatively, as well as at 12 months postoperatively.Results: The result indicated that the EPR group achieved better MVBH reduction (p < 0.001), UEPL reduction (p < 0.001), vertebral body fracture healing (p = 0.006), as well as implant breakage (p = 0.04) than the IS group; VWA (p < 0.001), CA (p = 0.005), AVBH (p < 0.001), MVBH (p < 0.001), UEPL (p < 0.001), and UIDH (p < 0.001) were lost after reduction less than those in the IS group. There was no significant difference in operative time (p = 0.315) and intraoperative bleeding (p = 0.274) between the 2 groups.Conclusion: The EPR group achieved better results in repositioning and maintaining MVBH and endplate morphology, with less correction loss after the reduction of the VWA, CA, AVBH, and endplate morphology. The EPR group exhibited a better healing pattern after vertebral fracture and disc degeneration was better relieved.
Collapse
Affiliation(s)
- Jiguang Hou
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
- Department of Orthopaedics, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Dong Ren
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Yufeng Chen
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Lindan Geng
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Shuangquan Yao
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Haotian Wu
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Pengcheng Wang
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
- Corresponding Author Pengcheng Wang Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province 050051, China
| |
Collapse
|