Posterior Pedicle Screw Fixation With Indirect Decompression Versus Direct Decompression in Treating Thoracolumbar Burst Fracture: A Systematic Review and Meta-Analysis

OBJECTIVE

To compare the safety and efficacy between posterior pedicle screw fixation with direct versus indirect decompression in treating patients with thoracolumbar burst fracture.

METHODS

This study was conducted on the basis of PRISMA statement. We systematically searched the PubMed and Embase databases up to July 3, 2023. Relevant studies comparing indirect decompression and direct decompression were recruited. Weighted mean differences (WMDs), odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed for continuous and dichotomous data, respectively. P < 0.05 was considered statistically significant.

RESULTS

The operation time (WMD: -37.14, 95% CI: [-42.64, 31.64], P < 0.00001, I2 = 0%) and intraoperative blood loss (WMD: -316.82, 95% CI: [-469.80, -163.85], P < 0.0001, I2 = 99%) of indirect decompression group were significantly lower. Percentage of anterior vertebral body height (WMD: 3.98, 95% CI: [2.36, 5.60], P < 0.00001, I2 = 32%) and encroachment rate of the spinal canal (WMD: 1.48, 95% CI: [0.56, 2.40], P = 0.002, I2 = 35%) of indirect decompression group were significantly higher. No statistical difference was identified in grades of neurologic recovery and Cobb angle.

CONCLUSIONS

Posterior pedicle screw fixation with indirect decompression was safe and effective for thoracolumbar burst fracture with or without neurologic deficits when posterior longitudinal ligament was intact.

Indirect Decompression Using Oblique Lumbar Interbody Fusion Revision Surgery Following Previous Posterior Decompression: Comparison of Clinical and Radiologic Outcomes Between Direct and Indirect Decompression Revision Surgery

OBJECTIVE

This study compared the radiological and clinical outcomes with transforaminal lumbar interbody fusion (TLIF) to evaluate the effect of indirect decompression through oblique lumbar interbody fusion (OLIF) as revision surgery.

METHODS

We enrolled patients who underwent single-level fusion with revision surgery at the same level as the previous decompression level. We retrospectively reviewed 25 patients who underwent OLIF from 2017 to 2018 and 25 who received TLIF from 2014 to 2018. Radiologic and clinical outcomes were evaluated by cross-sectional area (CSA) of the spinal canal, thickness and area of ligamentum flavum (LF), subsidence, disc height, fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS).

RESULTS

Compared with OLIF, the thickness and area of the LF after surgery were significantly less in TLIF, and the resulting CSA extension was also significantly higher. However, both groups showed improvement in ODI and VAS after surgery, and there was no difference between the groups. Complications related to the posterior approach in TLIF were 4 cases, and in OLIF, there were 2 cases that underwent additional posterior decompression surgery and 6 cases of transient paresthesia.

CONCLUSION

Since complications associated with the posterior approach can be avoided, OLIF is a safer and useful minimally invasive surgery. Therefore, appropriate indications are applied, OLIF is a good alternative to TLIF when revision surgery is considered.

Does Direct Surgical Decompression After Traumatic Spinal Cord Injury Influence Post-Traumatic Syringomyelia Rates? An 18-Year Single-Center Experience

OBJECTIVE

Risk factors for post-traumatic syringomyelia (PTS) development after traumatic spinal cord injury (tSCI) are incompletely understood. This study aimed to investigate the influence of direct surgical decompression after tSCI, as well as demographic, clinical, and other management-related factors, on rates of PTS development.

METHODS

A single-center case-control study was conducted on patients who presented with tSCI to a tertiary referral center over an 18-year period and received adequate follow-up. Cases were defined by both clinical suspicion and radiologic evidence of PTS. Demographic, clinical, and management-related data were collected and a multivariable logistic regression analysis performed.

RESULTS

A total of 286 patients were analyzed, of whom 33 (11.5%) demonstrated PTS. Direct surgical decompression with or without stabilization was performed in 190 of 286 patients, stabilization alone in 47, and non-surgical management in 49. On multivariable analysis, no significant influence on PTS risk was demonstrated for method of acute management (P > 0.05). A ten-year increase in age at injury was shown to decrease PTS rates by 0.72 (P = 0.01). Neurologically complete injury was associated with an increased rate of PTS, though this association did not achieve significance (P = 0.08). When only surgically managed patients were considered (n = 237), no significant influence on PTS rates was demonstrated for anterior decompression (adjusted odds ratio = 1.13, 95% CI = 0.34-3.74, P = 0.84) and for stabilization alone (adjusted odds ratio = 1.19, 95% CI = 0.39-3.61, P = 0.76) relative to posterior decompression.

CONCLUSIONS

Direct surgical decompression after tSCI was not demonstrated to significantly influence rates of PTS development. Age at injury and severity of injury should be considered as risk factors for PTS on follow-up.