Abstract
BACKGROUND: To evaluate the effectiveness and safety of fixation levels with pedicle screw fixation for thoracolumbar burst fractures (TLBF). METHODS: A systematic and comprehensive literature search was performed from inception to May 2024 in both English and Chinese databases, involving Medline, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, Chongqing VIP information, and SinoMed. Clinical trials of short-segment fixation and long-segment fixation (LSF) in the treatment of thoracolumbar burst fractures were included. Quality of included trials were assessed according to the methodological index for non-randomized studies (MINORS). Data analysis was conducted by using Review Manager 5.4 software and Stata. The quality of evidence in this systematic review was evaluated using the GRADE evidence quality evaluation system. RESULTS: Seventeen eligible trials with a total of 1031 patients were included in this meta-analysis. Meta-analysis revealed that intraoperative bleeding (MD = -36.64, 95% CI = -56.36 to -16.92, Z = 3.64, P = .0003) and operation time (MD = -25.73, 95% CI = -46.56 to -4.90, Z = 2.42, P = .02) in the LSF group were higher than those in the short-segment fixation group. There were no significant differences in terms of the final follow-up sagittal index (MD = 1.64, 95% CI = -0.75 to 4.03, Z = 1.35, P = .18) and the final follow-up Oswestry disability index (MD = -2.94, 95% CI = -9.74 to 3.85, Z = 0.85, P = .40) between the 2 groups. The LSF group had the advantages of better the final follow-up Cobb angle (MD = 2.52, 95% CI = 0.35-4.70, Z = 2.27, P = .02), the final follow-up visual analog scale (MD = 0.09, 95% CI = 0.04-0.14, Z = 3.59, P = .0003) and lower the final follow-up implant failure (MD = 3.43, 95% CI = 1.78-6.62, Z = 3.69, P = .0002). The funnel plots and Egger test showed some evidence of asymmetry, suggesting publication bias or small sample effect was existed. CONCLUSION: For thoracolumbar burst fractures, LSF can better improve patients' low back pain and better maintain postoperative orthopedic effect.