Abstract
Objective
This study aims to study the through a systematic review to identify the level of evidence and grade of recommendation for the diagnosis of nonunion in patients with traumatic fractures of the thoracolumbar spine.
Summary
The thoracolumbar spine fractures account for more than 50% of all fractures of the spine and a large proportion of acute injuries of the spinal cord, so predictable is the presence of nonunion or malunion in this type of fracture. Although some articles mention as one of the complications in these injuries to the nonunion, in national or world literature, there are no consistent data in terms of diagnosis and/or percentage. Therefore, we did a systematic review looking for the level of evidence and grade of recommendation for the diagnosis of nonunion in this type of injury.
Method
A study of systematic review designed according to the recommendations of the Cochrane Group were identified and searched for keywords, reason for the study, according to the criteria of the Medical Subject Heading (MeSH), which were researched through the Boolean algebra, using managers in primary and secondary search of the complete discharge of items. Articles obtained according to the search criteria were assessed in a standardized manner and blinded by two observers using the criteria of Jadad and Delphi. The statistical analysis was a description of the variables and then identify the values of agreement between observers using kappa values, considering how reliable the values of kappa = 0.80, p value = 0.05.
Results
The data provided by the two observers, yielded the following results: by type of study: zero articles as case reports, seven articles as a series of cases, six review articles, two clinic assays, and one cohort study. Regard to level of evidence: 14 articles with evidence level IV and 2 articles with evidence level III. With regard to recommendation grade: 14 articles with recommendation D and 2 articles with recommendation C. As for the statistical analysis, the percentage of agreement for Jadad was 100% and for Delphi 87%. The intraclass correlation coefficient for level of evidence and recommendation grades was 0.939.
Conclusions
(1) There is a low level of evidence (grade IV) and grade of recommendation (D) for the diagnosis of pseudoarthrosis in traumatic fractures of the thoracolumbar spine. (2) No single study is sufficient for the diagnosis of pseudoarthrosis in these fractures. (3) The literature on the problem of pseudoarthrosis in thoracolumbar spine are more focused on the pathology degenerative than traumatic thoracolumbar fractures. (4) Systematic reviews found no reference to this pathology. (5) Could not be diagnosticating the incidence of this pathology in the service of this hospital due to at not systematic clinical and radiographic criteria for the diagnosis of pseudoarthrosis in fractures of the thoracolumbar spine.