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How does vertical laminar fracture impact the decision-making in thoracolumbar fractures? A systematic scoping review and meta-analysis

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Abstract

Objective

Although vertical laminar fracture (VLF) is generally considered a severity marker for thoracolumbar fractures (TLFs), its exact role in decision-making has never been established. This scoping review aims to synthesize the research on VLF’s role in the decision-making of TLFs.

Methods

A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, and Web of Science from inception to  June 11, 2023, for studies examining the association of VLF in thoracolumbar fractures with dural lacerations, neurological deficits, radiographic parameters, or treatment outcomes. Additionally, experimental studies that analyze the biomechanics of burst fractures with VLF were included. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the association of VLF with dural laceration and neurological deficit, and ORs were pooled with a 95% confidence interval (CI).

Results

Twenty-eight studies were included in this systematic review, encompassing 2021 patients, and twelve were included in the meta-analysis. According to the main subject of the study, the association of VLF with a dural laceration (n = 14), neurological deficit (n = 4), radiographic parameters (n = 3), thoracolumbar fracture classification (n = 2), and treatment outcome (n = 2). Seven studies with a total of 1010 patients reported a significant association between VLF and neurological deficit (OR = 7.35, 95% CI [3.97, 14.25]; P < 0.001). The pooled OR estimates for VLF predicting dural lacerations were 7.75, 95% CI [2.41, 24.87]; P < 0.001).

Conclusion

VLF may have several important diagnostic and therapeutic implications in managing TLFs. VLF may help to distinguish AO type A3 from A4 fractures. VLF may help to predict preoperatively the occurrence of dural laceration, thereby choosing the optimal surgical strategy. Clinical and biomechanical data suggest VLF may be a valuable modifier to guide the decision-making in burst fractures; however, more studies are needed to confirm its prognostic importance regarding treatment outcomes.

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Authors and Affiliations

  1. Department of Neurosurgery, Mansoura University, Mansoura, Egypt

    Mohamed M. Aly

  2. Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Omar A. Abdelwahab

  3. King Fahd Central Hospital, Jazan, Saudi Arabia

    Mostafa M. E. Atteya

  4. Department of Diagnostic Radiology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia

    Abdulbaset M. Al-Shoaibi

  5. Department of Neurosurgery, Prince Mohamed Ben Abdulaziz Hospital, P.O Box 54146, 11514, Riyadh, Saudi Arabia

    Mohamed M. Aly

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  4. Abdulbaset M. Al-Shoaibi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MA, OAW, AA, and MA. First author wrote the first draft of the manuscript, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Mohamed M. Aly.

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Aly, M.M., Abdelwahab, O.A., Atteya, M.M.E. et al. How does vertical laminar fracture impact the decision-making in thoracolumbar fractures? A systematic scoping review and meta-analysis. Eur Spine J 33, 1556–1573 (2024). https://doi.org/10.1007/s00586-024-08140-w

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