{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T01:45:56Z","timestamp":1772675156149,"version":"3.50.1"},"reference-count":27,"publisher":"International College of Surgeons","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:p>Despite extensive research on thoracolumbar fractures, controversy still exists about which approach is the most appropriate. Lack of evidence-based practice may result in patients being treated inappropriately. The objective of study was to perform a systematic review of the effectiveness of the anterior and posterior approaches in the treatment of thoracolumbar fractures. We conducted searches of PubMed and the Cochrane Library, searching for relevant trials up to August 2013 that compared anterior and posterior for the treatment of thoracolumbar fractures. The key words \u201canterior,\u201d \u201cposterior,\u201d \u201cthoracolumbar fracture,\u201d \u201cCCT,\u201d and \u201cRCT\u201d were used. We assessed all included literature by using the Cochrane handbook (version 5.1). The results were expressed as the mean difference for continuous outcomes and risk difference for dichotomous outcomes, with a 95% confidence interval, using RevMan version 5.2. There were 3 randomized controlled trials and 11 clinical controlled trials included. The meta-analysis showed no significant difference between groups regarding Cobb angle, the Frankel scale, ASIA\/JOA motor score, complications, and number of patients returning to work. Compared with the anterior approach, the posterior approach demonstrated superior canal decompression. In the burst fracture subgroup, operative times were significantly shorter and perioperative blood loss was less in the posterior approach group. The posterior approach is more effective for canal decompression, operative times, and perioperative blood loss. However, because of the lack of randomized controlled trials, and because of large sample size studies, heterogeneity was significant between reports. The optimal treatment for thoracolumbar fractures requires further study.<\/jats:p>","DOI":"10.9738\/intsurg-d-14-00135.1","type":"journal-article","created":{"date-parts":[[2015,9,28]],"date-time":"2015-09-28T22:59:28Z","timestamp":1443481168000},"page":"1124-1133","source":"Crossref","is-referenced-by-count":47,"title":["Comparison of Anterior Versus Posterior Approach in the Treatment of Thoracolumbar Fractures: A Systematic Review"],"prefix":"10.9738","volume":"100","author":[{"given":"Qicong","family":"Zhu","sequence":"first","affiliation":[{"name":"Nanjing Medical University, Nanjing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengchao","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China"},{"name":"Department of Orthopedic Surgery, The Third People's Hospital, Yancheng, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weihua","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianling","family":"Bai","sequence":"additional","affiliation":[{"name":"Nanjing Medical University, Nanjing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huilin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4721","reference":[{"key":"i0020-8868-100-6-1124-b01","series-title":"J Spinal Disord Tech","article-title":"Anterior approach versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures: a prospective randomized controlled study","author":"Lin\n              B,","year":"in press","unstructured":"Lin\n              B, \n            \n              Chen\n              ZW, \n            \n              Guo\n              ZM, \n            \n              Liu\n              H, \n            \n              Yi\n              ZK.\n            \n          \n          Anterior approach versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures: a prospective randomized controlled study. 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J Spinal Disord Tech2005;18(suppl):S15\u2013S23"},{"issue":"7","key":"i0020-8868-100-6-1124-b03","series-title":"Spine","first-page":"667","article-title":"Evaluation of surgical treatment for burst fractures","volume":"15","author":"Esses\n              SI,","year":"1990","unstructured":"Esses\n              SI, \n            \n              Botsford\n              DJ, \n            \n              Kostuik\n              JP.\n            \n          \n          Evaluation of surgical treatment for burst fractures. 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Eur J Orthop Surg Traumatol2014;24(1):29\u201335"},{"issue":"2","key":"i0020-8868-100-6-1124-b12","series-title":"Orthopedics","first-page":"e219","article-title":"Anterior versus posterior approach in the treatment of chronic thoracolumbar fractures","volume":"35","author":"Chen\n              ZW,","year":"2012","unstructured":"Chen\n              ZW, \n            \n              Ding\n              ZQ, \n            \n              Zhai\n              WL, \n            \n              Lian\n              KJ, \n            \n              Kang\n              LQ, \n            \n              Guo\n              LX\n            \n          . Anterior versus posterior approach in the treatment of chronic thoracolumbar fractures. 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A new technique for the surgical management of unstable thoracolumbar burst fractures: a modification of the anterior approach and an outcome comparison to traditional methods.Neurosurg Focus1999;7(1):e3"},{"issue":"9","key":"i0020-8868-100-6-1124-b18","series-title":"Spine","first-page":"902","article-title":"Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection","volume":"28","author":"Dvorak\n              MF,","year":"2003","unstructured":"Dvorak\n              MF, \n            \n              Kwon\n              BK, \n            \n              Fisher\n              CG, \n            \n              Eiserloh\n              HL\n              III, \n            \n              Boyd\n              M, \n            \n              Wing\n              PC.\n            \n          \n          Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection. Spine2003;28(9):902\u2013908"},{"issue":"1","key":"i0020-8868-100-6-1124-b19","series-title":"J Spinal Disord Tech","first-page":"44","article-title":"Radiologic stability of titanium mesh cages for anterior spinal reconstruction following thoracolumbar corpectomy","volume":"17","author":"Robertson\n              PA,","year":"2004","unstructured":"Robertson\n              PA, \n            \n              Rawlinson\n              HJ, \n            \n              Hadlow\n              AT.\n            \n          \n          Radiologic stability of titanium mesh cages for anterior spinal reconstruction following thoracolumbar corpectomy. J Spinal Disord Tech2004;17(1):44\u201352"},{"issue":"3","key":"i0020-8868-100-6-1124-b20","series-title":"Acta Neurochir (Wien)","first-page":"299","article-title":"Unstable burst fractures of the thoraco-lumbar junction: treatment by posterior bisegmental correction\/fixation and staged anterior corpectomy and titanium cage implantation","volume":"148","author":"Payer\n              M.","year":"2006","unstructured":"Payer\n              M.\n            \n          \n          Unstable burst fractures of the thoraco-lumbar junction: treatment by posterior bisegmental correction\/fixation and staged anterior corpectomy and titanium cage implantation. 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J Neurosurg Spine2006;5(2):117\u2013125"},{"issue":"12","key":"i0020-8868-100-6-1124-b25","series-title":"Eur Spine J","first-page":"1759","article-title":"Anterior versus posterior surgery for osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine","volume":"15","author":"Uchida\n              K,","year":"2006","unstructured":"Uchida\n              K, \n            \n              Kobayashi\n              S, \n            \n              Matsuzaki\n              M, \n            \n              Nakajima\n              H, \n            \n              Shimada\n              S, \n            \n              Yayama\n              T\n            \n          . Anterior versus posterior surgery for osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine. Eur Spine J2006;15(12):1759\u20131767"},{"issue":"11","key":"i0020-8868-100-6-1124-b26","series-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi","first-page":"1327","article-title":"Comparative study of different operating methods in treating old thoracolumbar fractures with spinal cord injury [in Chinese]","volume":"22","author":"Shi\n              J,","year":"2008","unstructured":"Shi\n              J, \n            \n              Bai\n              L, \n            \n              Ding\n              H, \n            \n              Zhao\n              H, \n            \n              Wang\n              Z.\n            \n          \n          Comparative study of different operating methods in treating old thoracolumbar fractures with spinal cord injury [in Chinese]. 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