Chou Tzu-Yi, Tsuang Fon-Yih, Hsu Yu-Lun, Chai Chung Liang
School of Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan.
Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan.
Global Spine J. 2024 Mar;14(2):740-749. doi: 10.1177/21925682231181875. Epub 2023 Jun 9.
A systematic review and meta-analysis.
To update the systematic review comparing the outcomes between surgical and non-surgical treatment for thoracolumbar burst fractures without neurological deficit.
We registered a protocol in PROSPERO (ID: CRD42021291769) and searched Medline, Embase, Web of Science, and Google Scholar databases. Surgical and non-surgical treatments were compared in patients with thoracolumbar burst fractures without neurological deficits. Predefined outcomes at ≥6 months included pain (defined as a visual analog scale [VAS] of 0-100), functional outcomes (Oswestry Disability Index [ODI] of 0-50 and Roland-Morris Disability Questionnaire [RMDQ] of 0-24), and kyphotic angulation.
Nineteen studies involving 1056 patients were included in the analyses. For outcomes at ≥6 months, little to no difference was found in pain VAS score (mean difference, .95 [95% confidence interval {CI}, -6.02 to 7.92]; 827 participants; 15 studies; I = 92%), ODI (mean difference, -1.40 [95% CI, -5.11 to 2.31]; 446 participants; 7 studies; I = 79%), and RMDQ (mean difference, -.73 [95% CI, -5.13 to 3.66]; 216 participants; 5 studies; I = 77%). The kyphotic angulation in the surgery group was 6.35° lower than that in the non-surgery group (mean difference, -6.56° [95% CI, -10.26° to -2.87°]; 527 participants; ten studies; I = 86%). The trial sequential analysis indicated all outcomes reached adequate statistical power. The certainty of the evidence for all 4 outcomes was very low. For the analysis of minimally invasive procedures compared to traditional open surgeries, a statistically significant subgroup difference was found for VAS and ODI ( < .01 and < .04, respectively).
Surgical and non-surgical treatments showed little or no difference in outcomes at ≥6 months. This review provides a conclusion with adequate statistical power by including non-randomized studies. However, non-randomized studies also lowered the certainty of the evidence to a very low level.
系统评价与荟萃分析。
更新关于无神经功能缺损的胸腰椎爆裂骨折手术与非手术治疗效果比较的系统评价。
我们在PROSPERO（注册号：CRD42021291769）登记了一项方案，并检索了Medline、Embase、科学引文索引和谷歌学术数据库。对无神经功能缺损的胸腰椎爆裂骨折患者的手术和非手术治疗进行比较。≥6个月时的预定义结局包括疼痛（定义为视觉模拟量表[VAS]0 - 100）、功能结局（Oswestry功能障碍指数[ODI]0 - 50和罗兰-莫里斯功能障碍问卷[RMDQ]0 - 24）以及后凸角。
纳入分析的有19项研究，共1056例患者。对于≥6个月时的结局，疼痛VAS评分（平均差，0.95[95%置信区间{CI}，-6.02至7.92]；827名参与者；15项研究；I² = 92%）、ODI（平均差，-1.40[95%CI，-5.11至2.31]；446名参与者；7项研究；I² = 79%）和RMDQ（平均差，-0.73[95%CI，-5.13至3.66]；216名参与者；5项研究；I² = 77%）几乎没有差异。手术组的后凸角比非手术组低6.35°（平均差，-6.56°[95%CI，-10.26°至-2.87°]；527名参与者；10项研究；I² = 86%）。试验序贯分析表明所有结局均达到足够的统计效能。所有4项结局证据的确定性都非常低。对于微创与传统开放手术的比较分析，在VAS和ODI方面发现了具有统计学意义的亚组差异（分别P < 0.01和P < 0.04）。
手术和非手术治疗在≥6个月时的结局几乎没有差异。本综述通过纳入非随机研究得出了具有足够统计效能的结论。然而，非随机研究也将证据的确定性降至非常低的水平。
