Posterior Fixation and Fusion (PFF) versus Combined Anterior and Posterior Fixation and Fusion (CAPFF) for type B and C thoracolumbar spine injuries: a systematic review and meta-analysis.

BACKGROUND

A literature review and meta-analysis were conducted on studies comparing posterior fixation and fusion (PFF) and combined anterior and posterior fixation and fusion (CAPFF) for type B and C thoracolumbar injuries to determine the superior technique.

METHODS

A search of PubMed, Ovid Medline, Scopus, and the Cochrane Central Register was conducted from inception to September 2023. Randomized controlled trials and observational studies comparing PFF and CAPFF for B and C thoracolumbar injuries in adults were included. Excluded were reviews, non-English studies, studies involving children, pregnant women, other spinal pathologies, or different surgical treatments. Out of 5,773 articles, 8 were included for data extraction, and the recorded metrics included blood loss, operative time, cost, length of stay, follow-up, visual analogue scale (VAS) score, kyphosis angle, and patient age.

RESULTS

Across the included studies, 343 patients (228 = posterior approach, 115 = combined anterior posterior approach) were included, with follow-up ranging from 27-117.7 months. The surgical approach was randomly chosen in 2 of the 8 studies. Compared with the CAPFF approach, the PFF approach resulted in significantly less blood loss (Cohen's d = -1.70, p = 0.00) and cost (Cohen's d = -6.60, p = 0.01). PFF and CAPFF had similar postoperative lengths of stay; VAS-pain scores; pre, post, and final kyphosis angles; and patient age.

CONCLUSIONS

This study identifies some key differences between PFF and CAPFF for the treatment of B and C thoracolumbar injuries, including lower cost and blood loss for PFF, and no difference in pain as measured by the visual analogue scale (VAS), kyphosis angle, patient age, or postoperative length of stay. However, a lack of consistent metrics across studies underscores the need for additional research in this area. The selected data indicate that there may be benefits of PFF for patients compared with CAPFF, yet additional research is necessary to more definitively suggest a superior approach.