Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis on the Anterior and Posterior Approaches

BACKGROUND: A thoracolumbar burst fracture (BF) is a severe type of compression fracture, which is the most common type of traumatic spine fractures. Generally, surgery is the preferred treatment, but whether the optimal approach is either an anterior or a posterior approach remains unclear. This study aims to determine whether either method provides an advantage. METHODS: Following PRISMA guidelines, a systematic review was conducted, identifying studies comparing anterior versus posterior surgical approaches in patients with thoracolumbar BFs. Data were analyzed using Review Manager 5.3. Seven studies were included. RESULTS: An operative time of 87.97 min (53.91, 122.03; p<0.0001) and blood loss of 497.04 mL (281.8, 712.28; p<0.0001) were lower in the posterior approach. Length of hospital stay, complications, reintervention rate, neurological outcomes, postoperative kyphotic angle, and costs were similar between both groups. CONCLUSIONS: Surgical intervention is usually selected to rehabilitate patients with BFs. The data obtained from this study suggest that a posterior approach represents a viable alternative to an anterior approach, with various advantages such as a shorter operative time and decreased bleeding.