Meta analysis of operative versus non-operative treatment for thoracolumbar burst fracture without neurological deficit

Abstract

Objective To compare the outcomes of operative with non-operative treatment for thoracolumbar burst fracture without neurological deficit using Meta-analysis. Methods Electronic database were searched from inception to February 2014 by two independent reviewers, including Pubmed Medline, Excerpta Medica Database (Embase), Cochrane Central Register of Controlled Trials, Chinese Biology Medicine (CBM), Chinese Wanfang Database, and China National Knowledge Infrastructure (CNKI). Inclusion and exclusion criteria were applied to select the studies. Quality appraisal and data extraction were based on Cochrane Collaboration guidelines. Results Two randomized controlled trials (RCTs), which reported outcomes for 79 patients (41 with operative treatment and 38 with nonoperative treatment) at a follow-up of two years or more were included. Between-study heterogeneity was found to be significant, for one reported better results in surgery group concerning pain relief, function recovery and returning to work. However, opposite results were found in another trial. Meta-analysis showed surgery led to higher complication rates (RR=2.85, 95%CI 0.83-9.75), including subsequent surgery (RR=8.39, 95%CI 1.12-62.87). Conclusion Operative and nonoperative managements produce similar results with respect to pain relief, function regain, and returning to work when performed for thoracolumbar burst fractures without neurologic deficit, but operation is often associated with more complications. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Meta analysis