• Siddharth Sekhar Sethy, Nikhil Goyal, Kaustubh Ahuja, Syed Ifthekar, Samarth Mittal, Gagandeep Yadav, Venkata SudhakarPPDepartment of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, 249201, India., Bhaskar Sarkar, and Pankaj Kandwal.
• Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, 249201, India.
• Eur Spine J. 2022 Feb 1; 31 (2): 301-310.

Study DesignSystematic Review and Meta-analysis.PurposeThree-column injuries making the spine unstable require adequate fixation which can be achieved by anterior alone, posterior alone or combined anterior-posterior approach. There is no general consensus till date on a single best approach in sub-axial cervical spine trauma. This study comparing the three approaches is an attempt to establish a firmer guideline in this disputed topic.Material And MethodsThe protocol was registered with PROSPERO. PubMed, Embase and Google Scholar were searched for relevant literature. For each study, pre-defined data were extracted which included correction of kyphosis, loss of correction, hospital stay, operative time, blood loss during surgery as the outcome variables. Studies were also screened for the complications.ResultsEleven studies were evaluated for qualitative analysis and quantitative synthesis of the data in our review. The result demonstrated significant difference with most correction achieved in combined approach subgroup. Though no significant difference was found, the anterior group was having maximum loss of correction. Combined approach showed significantly more operative time and blood loss followed by posterior approach and then anterior approach alone. The improvement in VAS was significantly more in anterior subgroup when compared to combined approach.ConclusionCervical alignment is best restored by combined approach compared to the other two. Anterior only approach showed more correction than posterior approach. However, there is no significant difference between all three approaches in loss of correction at long-term follow-up. Anterior only approach is superior to posterior and combined approach on basis of intraoperative and perioperative parameters.Level Of Evidence IDiagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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