Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States.
Global Spine J. 2015 Feb;5(1):73-82. doi: 10.1055/s-0034-1396047. Epub 2014 Nov 24.
Study Design Systematic literature review. Objective The management of traumatic thoracolumbar burst fractures (TLBF) remains challenging, and analyzing the levels of evidence (LOEs) for treatment practices can reform the decision-making process. However, no review has yet evaluated the operative management of traumatic thoracolumbar burst fractures with particular attention placed on LOE from an established methodology. The objective of the present study was to characterize the literature evidence for TLBF, specifically for operative management. Methods A comprehensive search of the English literature over the past 20 years was conducted using PubMed (MEDLINE). The inclusion criteria consisted of (1) traumatic burst fractures (2) in the thoracic or lumbar spine. Exclusion criteria included (1) osteoporotic burst fractures, (2) pathologic burst fractures, (3) cervical fractures, (4) biomechanical studies or those involving cadavers, and (5) computer-based studies. Studies were assigned an LOE and those meeting level 1 or 2 were included. Results From 1,138 abstracts, 272 studies met the criteria. Twenty-three studies (8.5%) met level 1 (n = 4, 1.5%) or 2 (n = 19, 7.0%) criteria. All 23 studies were reported. Conclusions The literature contains a high LOE to support the operative management of traumatic thoracolumbar burst fractures. For patients who are neurologically intact, a high LOE demonstrated similar functional outcomes, lower complication rates, and less costs with conservative management when compared with surgical management. There is a high LOE for short- or long-segment pedicle instrumentation without fusion and less invasive (percutaneous and paraspinal) approaches. Furthermore, the posterior approaches are associated with lower complications as opposed to the anterior or combined approaches.
系统文献回顾。目的：创伤性胸腰椎爆裂骨折（TLBF）的治疗仍然具有挑战性，分析治疗实践的证据水平（LOE）可以改进决策过程。然而，尚无研究从既定方法学的角度评估创伤性胸腰椎爆裂骨折的手术治疗。本研究的目的是描述 TLBF 文献证据，特别是手术治疗的证据。方法：使用 PubMed（MEDLINE）对过去 20 年的英文文献进行全面检索。纳入标准包括：（1）创伤性爆裂骨折；（2）胸腰椎。排除标准包括：（1）骨质疏松性爆裂骨折；（2）病理性爆裂骨折；（3）颈椎骨折；（4）生物力学研究或涉及尸体的研究；（5）基于计算机的研究。研究被分配了 LOE，仅纳入 LOE 为 1 级或 2 级的研究。结果：从 1138 篇摘要中，有 272 篇研究符合标准。23 项研究（8.5%）符合 1 级（n=4，1.5%）或 2 级（n=19，7.0%）标准。所有 23 项研究均有报道。结论：文献提供了支持创伤性胸腰椎爆裂骨折手术治疗的高 LOE。对于神经功能完整的患者，与手术治疗相比，保守治疗具有更高的 LOE，可获得相似的功能结果、更低的并发症发生率和更低的成本。短节段或长节段椎弓根内固定而不融合以及微创（经皮和经脊柱旁）方法具有更高的 LOE。此外，与前路或联合入路相比，后路入路与较低的并发症相关。
