Is it useful to apply transpedicular intracorporeal bone grafting to unstable thoracolumbar fractures? A systematic review

The debate over the use of intracorporeal bone graft in treating unstable thoracolumbar fractures continues. We compiled evidence for the effect of transpedicular intracorporeal bone grafting (TPG) on outcome in patients with traumatic thoracolumbar fractures. A systematic review was conducted to compare the outcomes of short segment fixation and posterolateral fusion (PLF) with or without TPG. We reviewed articles in PubMed, Ovid, and the Cochrane Database published between January 1995 and August 2011. The correction loss and hardware failure between TPG and TPG+PLF were compared. We assessed the methodological quality of the studies according to the inclusion criteria. We divided 19 papers, involving 22 series, into two groups: posterolateral fusion, and posterolateral fusion combined with intracorporeal bone graft. Meta-analysis regression revealed statistically significant differences in correction loss and hardware failure between the two groups. There were no statistically significant differences in average age, follow-up period, fracture levels, or application of orthosis rate between the two groups. PLF+TPG reduces hardware failure and correction loss compared with PLF alone. It also minimizes the likelihood of severe correction loss. For serious spinal injury cases, PLF+TPG was recommended to improve the prognosis. Further studies would be useful in determining the benefits of applying this method to the treatment of unstable thoracolumbar fractures.