Meta-analysis of anterior screw fixation versus posterior cervical fusion in treatment of odontoid fractures

Zha Yuan-yu; Yang Yang; Zhou Yi-chi; Wei Ren-xiong; Zhang Shu-wei; Jin Wei

doi:10.3969/j.issn.2095-4344.2016.48.021

Abstract：BACKGROUND:Many studies concern the comparison of anterior screw fixation and posterior cervical fusion for odontoid fractures, but the sample size of many studies has limitations. There is lack of objective evaluation on advantages and disadvantages of two surgical methods. <br> OBJECTIVE:This is a meta-analysis to compare the clinical results between anterior screw fixation versus posterior cervical fusion for odontoid fractures. <br> METHODS:A systematic search of al the studies published was conducted on the PubMed, the Cochrane Central Register of Control ed Trials (CENTRAL), EMbase, the ISI Web of Knowledge Database, CNKI, VIP, CMB and Wanfang databases. Randomized and non-randomized control ed trials that compared between anterior and posterior approaches for odontoid fracture were identified from database foundation to March 1, 2016. The references were also searched by hand. Meta-analyses were performed by using the Rev-Man 5.3 software, provided by the Cochrane Col aboration. <br> RESULTS AND CONCLUSION:(1) Twelve studies involving 514 patients were included. Among the patients, 287 underwent anterior approach and 227 underwent posterior approach. (2) The results of the meta-analysis indicated that, compared with posterior approach, anterior approach has advantages of less blood loss, shorter operative time, and a smal degree of cervical rotation injury (P<0.05). No statistical difference was determined in bone union and complication rate (P>0.05). (3) These results suggested that both anterior and posterior approaches were demonstrated to be effective for odontoid fractures. Anterior screw fixation had obvious advantages:less bleeding, short operating time, smal trauma and less spine injury. Thus, it is an ideal procedure to treat odontoid fractures. However, the operative approach <br> should be chosen individual y in clinical work.