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Comparison of anterior-only versus combined anterior and posterior fusion for unstable subaxial cervical injuries: a meta-analysis of biomechanical and clinical studies

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Abstract

Objective

The purpose of the present study was to perform a meta-analysis comparing biomechanical and clinical outcomes between anterior-only and combined anterior and posterior fusions to determine which method of cervical fusion yielded better results for unstable cervical injuries.

Methods

The MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and SCOPUS electronic databases were searched for relevant articles published through 2000–2019 that compared the biomechanical and clinical outcomes of anterior-only and combined anterior and posterior fusion for unstable cervical fracture.

Results

Eight biomechanical and four clinical studies were included in the analysis. There were significant biomechanical differences between the groups with respect to flexion–extension, axial rotation and lateral bending. Combined fusion provided better biomechanical stability for unstable cervical injuries than anterior-only fusion, regardless of the number of corpectomies or the presence of a posterior column injury. However, despite significant biomechanical differences, there were no significant differences in clinical outcomes, such as the degree of neurologic improvement and complications between the two groups.

Conclusion

Anterior-only and combined anterior and posterior fusions for unstable subaxial cervical injuries can both restore cervical stability. Although combined fusion might have some advantages in terms of stability biomechanically, there were no significant differences in clinical outcomes, such as the degree of neurologic improvement and perioperative complications. Therefore, rather than the routine use of combined fusion for unstable cervical injuries, the selective use of anterior-only or combined fusion according to the type of injury is recommended.

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Funding

This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2018R1D1A1B07049185).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Barun Hospital, Jinju, Republic of Korea

    Dong-Yeong Lee

  2. Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, 15, Jinju-daero 816 beon-gil, Jinju-si, 660-751, Gyeongsangnam-do, Republic of Korea

    Young-Jin Park, Myung-Geun Song, Kun-Tae Kim & Dong-Hee Kim

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  1. Dong-Yeong Lee
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Correspondence to Dong-Hee Kim.

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Lee, DY., Park, YJ., Song, MG. et al. Comparison of anterior-only versus combined anterior and posterior fusion for unstable subaxial cervical injuries: a meta-analysis of biomechanical and clinical studies. Eur Spine J 30, 1460–1473 (2021). https://doi.org/10.1007/s00586-020-06704-0

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  • DOI: https://doi.org/10.1007/s00586-020-06704-0

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