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Título

Thoracolumbar burst fracture: McCormack load-sharing classification – systematic review and single-arm meta-analysis

Objetivo

STUDY DESIGN: A systematic review and single-arm meta-analysis of randomized

clinical trials.

OBJECTIVE: To evaluate if the load-sharing classification (LSC) is reliable to predict

the best surgical approach for thoracolumbar burst fracture (TBF).

SUMMARY OF BACKGROUND DATA: There is no previous review evaluating the

efficacy of the use of LSC as a guide in the surgical treatment of burst fractures

Metodologia

METHODS: On April 19th, 2019, a broad search was performed in the following

databases: EMBASE, PubMed, Cochrane, SCOPUS, Web of Science, LILACS, and grey

literature. This study was registered on the International Prospective Register of

Systematic Reviews. We included clinical trials involving patients with TBF undergoing

posterior surgical treatment, classified by load-sharing score, and that enabled the

analysis of the outcomes loss of segmental kyphosis and implant failure. We performed

random or fixed effects models meta-analyses depending on the data homogeneity.

Heterogeneity between studies was estimated by I2 and τ2 statistics

Resultados

RESULTS: The search identified 189 references, out of which nine studies were eligible

for this review. All papers presenting LSC up to 6 proved to be reliable in indicating that

only posterior instrumentation is necessary, without screw failures or loss of kyphosis

correction. For cases where the LSC was higher than 6, only 2.5% of the individuals

presented implant failure upon posterior approach alone. For loss of kyphosis correction,

only 5% of patients had this outcome where LSC > 6. For both outcomes together, we

had 6% of postoperative problems (I2 = 77%, τ2 < 0.0015, p<0.01).

Conclusões

CONCLUSION: Load-sharing scores up to 6 are 100% reliable, only requiring posterior

instrumentation for stabilization. For scores higher than 6, the risk of implant breakage

and loss of kyphosis correction in posterior fixation alone is low. Thus, other factors

should be considered to define the best surgical approach to be adopted.



Level of Evidence I.



Keywords: Thoracolumbar burst fracture; Load-sharing classification

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