Anterior, Posterior and Anterior–Posterior Approaches for the Treatment of Thoracolumbar Burst Fractures: A Network Meta-Analysis of Randomized Controlled Trials

Figures & data

Figure 1. A flow diagram of study selection.

Figure 2. Network of the comparisons for the Bayesian network meta-analysis. Note: 1: anterior approach; 2: posterior approach; 3: anterior-posterior approach.

Table 1. Patient and study characteristics of the included studies in the network meta-analysis.

Study	Year	Country	Treatment	Sample size	Mean age	Gender(M:F)	Follow-up(month)	outcomes
Esses et al. [2]	1990	Canada	A VS P	18:22	34.8/34.2	13:5/12:10	20.1(12-34)	5
Gumussuyu et al. [19]	2019	Turkey	P VS AP	13:14	40 ± 10.3/37.0 ± 14.2	3:10/5:9	117.7 ± 8.7	2,3,4,5,6
Jiang et al. [20]	2019	China	A VS P	40:40	NS	NS	6	1,2,3
Li et al. [21]	2016	China	A VS P	50:50	32.48 ± 9.63/36.25 ± 10.23	24:26/26:24	1	3
Lin et al. [22]	2011	China	A VS P	32:32	37.8 ± 5.8/39.3 ± 7.5	14:18/16:16	46.5 ± 14.2/43.7 ± 13.6	1,2,3,4
Scholz et al. [23]	2018	Germany	P VS AP	10:7	48.9(22-64)/42.7(25-61)	5:5/4:3	24	3
Wang et al. [24]	2015	China	A VS P VS AP	22:23:21	37.2 ± 11.4/40.5 ± 13.5/41.2 ± 12.9	14:8/15:8/16:5	73 ± 7.8/69 ± 9.1/71 ± 8.9	1,2,3,4,5,6
Wood et al. [25]	2005	American	A VS P	20:18	39(18-56)/42(19-68)	12:8/13:5	43.5(24-108)	1,2,3,4,5,6
Zhang et al. [26]	2022	China	A VS AP	60:60	45.26 ± 4.09/45.37 ± 4.24	29:31/35:25	2	1,2,3

Note: NS: not specified; A anterior approach; P posterior approach; AP combined anterior-posterior approach. outcomes: 1: surgical duration 2: intraoperative bleeding volume 3: Cobb angle 4: VAS score 5: Implant failure rate 6: infection rate.

Table 2. Detsky quality Scores of the included randomized controlled trials.

Item		Esses [2]	Lin [22]	Wood[25]	Wang[24]	Gumussuyu [19]	Jiang [20]	Li [21]	Scholz [23]	Zhang [26]
Randomization	Were the patients assigned randomly?	1	1	1	1	1	1	1	1	1
	Description of randomization	0	1	1	2	2	0	2	2	1
	Do you believe there could have been bias in treatment assignment?	0	0	0	1	1	0	1	1	0
Outcome	Was there a description of the criteria for measuring outcomes?	1	1	1	1	1	1	1	1	1
	Were the criteria objective?	2	2	2	2	2	1	2	2	1
	Were outcome assessors blind to treatment?	0	0	0	1	0	0	0	1	0
Eligibility	Were inclusion/exclusion criteria clearly defined?	0	2	2	2	2	1	2	2	2
	Do you know how many patients were excluded from the trial?	2	0	2	2	2	0	2	2	0
Therapy	Was the therapeutic regimen fully described for the treatment group?	2	2	2	2	2	1	2	2	2
	Was the therapeutic regimen Fully described for the control group?	2	2	2	2	2	1	2	2	2
Statistical analysis	Was there a statistical analysis? (Test Stated and P Value)	1	1	1	1	1	0	0	1	2
	Was the statistical analysis appropriate?	1	2	2	2	2	2	2	2	2
	If the trial was negative, were confidence intervals or post hoc power calculations performed?	0	0	0	0	0	0	0	0	0
	Was there a sample size justification before the study?	0	0	0	0	0	0	0	1	0
	Total score	12	14	16	19	18	8	17	20	14

Figure 3. Funnel plot of this network meta-analysis. Note: 1: anterior approach; 2: posterior approach; 3: anterior-posterior approach.

Figure 4. Loop inconsistency plot of this network meta-analysis. Note: 1: anterior approach; 2: posterior approach; 3: anterior-posterior approach.

Figure 5. Forest Interval plot of this network meta-analysis. Note: 1 = A: anterior approach; 2 = B: posterior approach; 3 = C: anterior-posterior approach.

Figure 6. SUCRA Of this network meta-analysis. Note: 1: anterior approach; 2: posterior approach; 3: anterior-posterior approach.