European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society | 2024 | Aly MM, Abdelwahab OA, Atteya MME, Al-Shoaibi AM
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[Indexed for MEDLINE] 4. Expert Rev Med Devices. 2024 May;21(5):411-425. doi: 10.1080/17434440.2024.2341109. Epub 2024 Apr 10. Is open anterior advantageous to posterior decompression and reconstruction in fresh A(3) to C(3)/AO type thoracolumbar junction fractures? A systematic review. Korovessis P(1), Syrimpeis V(2), Korovesis A(3). Author information: (1)Orthopedics, General Hospital Patras Greece, Patras, Greece. (2)Electrical and Computer Engineering, University of the Peloponnese School of Engineering, Patras, Greece. (3)Open University of Patras, Patra, Greece. INTRODUCTION: Surgical outcomes of open anterior and open posterior approaches, for thoracolumbar A3 to C3/AO type fractures, are compared. METHODS: A PubMed search was conducted from 1990 to 2024 related to anterior, posterior, and combined approaches. Inclusion criteria: Fresh traumatic T10 to L2 fractures, age ≥13 years, ≥10 cases, minimum follow-up 6 months. Exclusion criteria: Cadaveric studies, pathological fractures, reviews, thoracoscopy-assisted, mini-open lateral (MOLA) and minimal invasive anterior or posterior approaches. Coleman Methodology Scores (CMS) (modified for spinal trauma) indicated potential selection bias in the selected studies. PRISMA guidelines were adapted. RESULTS: Nineteen studies with 847 participants were selected. The average CMS quality score was fair. The anterior approach, although it better decompresses the compromised spinal canal, it is also associated with increased surgical complications compared to the posterior approach. The neurological outcome, the loss of correction and the reoperation rate, were similar to both approaches. This systematic review favors posterior approach. CONCLUSIONS: The anterior approach is demanding and is associated with a higher rate of surgical complications compared to the posterior approach. The limitations of the selected studies included inconsistence in the: 1) approaches selection, 2) classifications of the fracture types and the neurological status and 3) variety of instrumentations used. PROSPERO ID: CRD42023484222. DOI: 10.1080/17434440.2024.2341109
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