Posterior-only fixation reduces blood loss, operative time, and hospital stay in thoracolumbar burst fractures

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European journal of orthopaedic surgery & traumatology : orthopedie traumatologie Published June 7, 2026 Medically reviewed June 7, 2026 Study authors: Boutros Marc, Awad Guy, Hammad Shaza, Khatib Reina, Smadi Zina, Assi Chahine PubMed ↗ DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider posterior-only fixation for thoracolumbar burst fractures to reduce perioperative morbidity without compromising neurological recovery.

This meta-analysis compared posterior-only fixation versus combined anterior-posterior fixation in 1553 patients with thoracolumbar burst fractures. The analysis found that posterior-only fixation was associated with significantly reduced blood loss (mean difference -438.21 mL, p < 0.001), operative time (mean difference -121.66 min, p < 0.001), hospital stay (mean difference -5.62 days, p < 0.001), and pulmonary complications (risk ratio 0.16, p = 0.009).

No significant differences were observed between the two approaches for neurological improvement, pain scores, functional recovery (ODI, RMDQ), radiological correction (Cobb angle, canal compromise), infection rates, or instrumentation failure. The authors note that most included evidence remains observational and there was substantial heterogeneity for perioperative outcomes.

Surgical decision-making should be individualized based on fracture morphology, neurological status, and patient-specific factors. The findings suggest that posterior-only fixation may offer perioperative advantages without compromising clinical or radiological outcomes, but the observational nature of much of the evidence warrants cautious interpretation.

Study Details

Study typeMeta analysis

Sample sizen = 1,553

EvidenceLevel 1

PublishedJun 2026

PMID42249999

View Original Abstract ↓

BACKGROUND: Thoracolumbar burst fractures are among the most common spinal injuries, and optimal surgical management remains controversial. Evidence comparing posterior-only and combined anterior-posterior fixation strategies remains inconsistent. METHODS: A systematic search of PubMed, Scopus, Cochrane Library, and Google Scholar was conducted up to November 2025 to identify comparative studies evaluating posterior-only versus combined anterior-posterior fixation for thoracolumbar burst fractures. Nineteen studies (predominantly retrospective; 15 non-randomized and 4 randomized) met inclusion criteria, comprising 1553 patients. Outcomes included perioperative parameters (operative time, blood loss, hospital stay), neurological recovery (Frankel scores), pain and functional outcomes (VAS, ODI, RMDQ, return-to-work rates), radiological parameters (Cobb angle correction, canal compromise recovery), and complication rates (infection, instrumentation failure, pulmonary complications). RESULTS: Posterior-only fixation was associated with significantly reduced blood loss (MD = - 438.21 mL, p < 0.001), shorter operative time (MD = - 121.66 min, p < 0.001), and shorter hospital stay (MD = - 5.62 days, p < 0.001), although heterogeneity was substantial for perioperative outcomes. Pulmonary complications were also lower in the posterior group (RR = 0.16, p = 0.009). No significant differences were found between approaches in neurological improvement, pain scores, functional recovery, radiological correction, infection rates, or instrumentation failure. CONCLUSIONS: Both posterior-only and combined anterior-posterior fixation show broadly similar neurological, radiological, and functional outcomes in thoracolumbar burst fractures. Posterior-only fixation was associated with perioperative advantages and a lower risk of pulmonary complications. Surgical decision-making should therefore be individualized based on fracture morphology, neurological status, and patient-specific factors, particularly given that most included evidence remains observational.