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Cochrane Database of Systematic Reviews

Tratamiento quirúrgico versus no quirúrgico para las fracturas toracolumbares por estallido sin déficit neurológico

Información

DOI:
https://doi.org/10.1002/14651858.CD005079.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 06 junio 2013see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Lesiones óseas, articulares y musculares

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Minawaer Abudou

    The Eye Department of the First Affiliated Hospital, Xinjiang Medical University, Xinjiang, China

  • Xueyi Chen

    Eye Department, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China

  • Xiangyu Kong

    Department of Epidemiology, Chengdu Medical College, Chengdu, China

  • Taixiang Wu

    Correspondencia a: Chinese Clinical Trial Registry, Chinese Ethics Committee of Registering Clinical Trials, West China Hospital, Sichuan University, Chengdu, China

    [email protected]

Contributions of authors

Minawaer Abudu: protocol development, searching for trials, quality assessment of trials, data extraction, data analysis, review development.
Xingyu Kong: searching for trials, quality assessment of trials, data extraction, data analysis.
Wu Taixiang: quality assessment of trials, statistical advice, review development.
Chen Xueyi: supervisor for development of the review.

Declarations of interest

None known.

Acknowledgements

We are very grateful for valuable comments and support from Bill Gillespie, Helen Handoll and Cumhur Kilincer on drafts of this updated review.

We thank Janet Wale, Peter Herbison, Rajan Madhok and Jeremy Fairbank for their comments on the first version of the review. We also thank Marc Swiontkowski for helpful comments on the protocol. We are also grateful to Lindsey Elstub, Joanne Elliott and Lesley Gillespie of the Cochrane Bone, Joint and Muscle Trauma Group.

Thanks too to Yuan Hao for preparing the first version of this updated review. In addition, the review authors who prepared the protocol and first version of the review are gratefully acknowledged: Liao Yi, Bai Jingping, Jin Cele and XiLin Baoleri.

Version history

Published

Title

Stage

Authors

Version

2013 Jun 06

Surgical versus non‐surgical treatment for thoracolumbar burst fractures without neurological deficit

Review

Minawaer Abudou, Xueyi Chen, Xiangyu Kong, Taixiang Wu

https://doi.org/10.1002/14651858.CD005079.pub3

2006 Oct 18

Operative versus non‐operative treatment for thoracolumbar burst fractures without neurological deficit

Review

Liao Yi, Bai Jingping, Jin Gele, Taixiang Wu, XiLin Baoleri

https://doi.org/10.1002/14651858.CD005079.pub2

2005 Jan 24

Operative versus non‐operative treatment for thoracolumbar burst fractures without neurological deficit

Protocol

Liao Yi, Bai Jingping, Jin Gele, XiLin Baoleri, Wu Taixiang

https://doi.org/10.1002/14651858.CD005079

Differences between protocol and review

  1. Reappraisal of Types of outcome measures led to the downgrading of economic evaluation to a secondary outcome and removal of the secondary outcome 'correlation between the final amount of kyphosis/canal compromise and the pain reported or disability' ‐ this was still reported but not as a measure of treatment effect.

  2. We assessed risk of bias instead of study methodological quality.

  3. In the protocol, we planned to synthesise data but as only two trials with substantial heterogeneity were included, only limited meta‐analysis was possible.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Surgical versus non‐surgical treatment, Outcome 1 Visual Analogue Pain Scores (0 to 100 mm: worst) at follow‐up.
Figuras y tablas -
Analysis 1.1

Comparison 1 Surgical versus non‐surgical treatment, Outcome 1 Visual Analogue Pain Scores (0 to 100 mm: worst) at follow‐up.

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Comparison 1 Surgical versus non‐surgical treatment, Outcome 2 Roland and Morris Questionnaire at follow‐up (0 to 24: worst result).
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Analysis 1.2

Comparison 1 Surgical versus non‐surgical treatment, Outcome 2 Roland and Morris Questionnaire at follow‐up (0 to 24: worst result).

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Comparison 1 Surgical versus non‐surgical treatment, Outcome 3 Visual Analogue Scale Spine Score (0 to 100 mm: best) at follow‐up.
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Analysis 1.3

Comparison 1 Surgical versus non‐surgical treatment, Outcome 3 Visual Analogue Scale Spine Score (0 to 100 mm: best) at follow‐up.

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Comparison 1 Surgical versus non‐surgical treatment, Outcome 4 Oswestry Questionnaire at minimum 24 months follow‐up.
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Analysis 1.4

Comparison 1 Surgical versus non‐surgical treatment, Outcome 4 Oswestry Questionnaire at minimum 24 months follow‐up.

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Comparison 1 Surgical versus non‐surgical treatment, Outcome 5 Return to work.
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Analysis 1.5

Comparison 1 Surgical versus non‐surgical treatment, Outcome 5 Return to work.

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Comparison 1 Surgical versus non‐surgical treatment, Outcome 6 Subsequent surgery (for complications).
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Analysis 1.6

Comparison 1 Surgical versus non‐surgical treatment, Outcome 6 Subsequent surgery (for complications).

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Comparison 1 Surgical versus non‐surgical treatment, Outcome 7 Complications.
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Analysis 1.7

Comparison 1 Surgical versus non‐surgical treatment, Outcome 7 Complications.

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Comparison 1 Surgical versus non‐surgical treatment, Outcome 8 Kyphosis at follow‐up (degrees).
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Analysis 1.8

Comparison 1 Surgical versus non‐surgical treatment, Outcome 8 Kyphosis at follow‐up (degrees).

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Comparison 1 Surgical versus non‐surgical treatment, Outcome 9 Degree of canal compromise (% occlusion) at 2 years.
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Analysis 1.9

Comparison 1 Surgical versus non‐surgical treatment, Outcome 9 Degree of canal compromise (% occlusion) at 2 years.

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Table 1. Siebenga 2006: individual patient data for patient‐reported outcomes of pain and disability

VAS pain (0 to 100 mm: no pain)

at final follow‐up

VAS spine score (0 to 100 mm: best outcome)

at final follow‐up

RMDQ‐24 at final follow‐up

Surgical

Non‐surgical

Surgical

Non‐surgical

Surgical

Non‐surgical

55

80

45

80

14

4

100

60

100

29

0

15

95

65

99

55

0

10

76

15

58

11

13

24

90

65

94

54

2

9

100

98

86

94

0

0

100

90

100

82

0

13

100

65

65

53

2

14

95

100

62

100

0

0

79

100

74

86

1

0

100

65

86

34

0

15

70

65

89

56

6

10

82

80

76

80

5

0

99

55

92

46

0

15

86

80

90

62

2

5

80

74

3

77

88

4

VAS = visual analogue scale
Figuras y tablas -
Table 1. Siebenga 2006: individual patient data for patient‐reported outcomes of pain and disability
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Table 2. Wood 2003: individual patient data for patient‐reported outcomes of pain and disability

VAS pain (0 to 10 cm: worst)
at final follow‐up

Roland and Morris Questionnaire
at final follow‐up

Oswestry Questionnaire
at final follow‐up

Surgical

Non‐surgical

Surgical

Non‐surgical

Surgical

Non‐surgical

1

2

5

**

4

**

1

5

3

12

4

50

1.5

0

6

1

14

0

5

2

16

0

20

2

1

1

1

2

6

4

5

5

10

3

24

12

3

2

13

0

30

2

0

0

1

0

2

0

5

1

4

0

20

0

2

1.5

4

2

24

12

2

0

6

0

20

0

7.5

0

19

1

40

0

6

0

14

2

30

10

1

1

0

0

0

2

1

9

7

24

16

52

4

0

2

0

8

0

4

1

9

1

34

6

3

8

6

20

18

20

7

4

19

9

40

22

6

1

15

2

48

22

1

0

6

1

44

4

6

0

19

**

48

**

1

1

5

1

0

4

5

6

4

** = missing value
VAS = visual analogue scale

Figuras y tablas -
Table 2. Wood 2003: individual patient data for patient‐reported outcomes of pain and disability
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Table 3. Wood 2003: SF‐36 scores for 8 domains at final follow‐up

Domain

Surgery

Non‐surgery

P Value

Pain

59

72

0.07

Health Perception

69

72

0.4

Physical Function

63

86

0.002

Social Function

84

83

0.8

Role; Physical

51

85

0.003

Role; Emotional

80

78

0.92

Mental Health

81

75

0.3

Energy/Fatigue

84

56

0.8
Figuras y tablas -
Table 3. Wood 2003: SF‐36 scores for 8 domains at final follow‐up
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Table 4. Complications

Complications

Wood 2003

Siebenga 2006

Surgical

Non‐surgical

Surgical

Non‐surgical

Wound dehiscence

2

Instrumentation/bone failure

2

1

Wound infection

1 deep

2 (1 deep)

Pseudarthrosis

1

Neurapraxia

1

Ketoacidosis

1

Instrumentation break

2

1

Urinary tract infection

2

1

Seroma

1

Instrumentation removal (for complication)

6

2

Skin blisters

1

Severe pain at the bone harvest site

1

Conus medullaris syndrome

1

Continued use of orthosis reflecting irrational fear
of neurologic deterioration. Severe depression.

1

Scoliosis (and signs of nerve root compression)

1

Total

19

2

7

3

Note there are repeated counts in this table.
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Table 4. Complications
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Table 5. Correlation between the final amount of kyphosis or canal compromise and the reported pain or disability

Siebenga 2006

RMDQ‐24

VAS spine score

VAS pain

LSA

RSA

LSA

RSA

LSA

RSA

r = ‐0.30,

P = 0.09

r= ‐0.29,

P = 0.11

r = 0.20,

P = 0.29

r = 0.17,

P = 0.38

r = 0.20,

P = 0.29

r = 0.17,

P = 0.38

Wood 2003

kyphosis and pain score

Roland and Morris questionnaire

Oswestry questionnaire

Surgical group

r = 0.05; P = 0.8

r = 0.05; P = 0.8

r = 0.3; P = 0.14

Non‐surgical group

r = 0.22; P = 0.29

r = 0.19; P = 0.39

r = 0.25; P = 0.27

LSA = local sagittal angle
P = P value
r = correlation coefficient
RMDQ‐24 = Roland Morris Disability Questionnaire (score 0 to 24)
RSA = regional sagittal angle
VAS = visual analogue score or scale

Figuras y tablas -
Table 5. Correlation between the final amount of kyphosis or canal compromise and the reported pain or disability
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Comparison 1. Surgical versus non‐surgical treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Visual Analogue Pain Scores (0 to 100 mm: worst) at follow‐up Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Roland and Morris Questionnaire at follow‐up (0 to 24: worst result) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Visual Analogue Scale Spine Score (0 to 100 mm: best) at follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 Oswestry Questionnaire at minimum 24 months follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 Return to work Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6 Subsequent surgery (for complications) Show forest plot

2

79

Risk Ratio (M‐H, Fixed, 95% CI)

8.39 [1.12, 62.87]

7 Complications Show forest plot

2

79

Risk Ratio (M‐H, Random, 95% CI)

2.85 [0.83, 9.75]

8 Kyphosis at follow‐up (degrees) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

9 Degree of canal compromise (% occlusion) at 2 years Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. Surgical versus non‐surgical treatment
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