Response to: Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterior-only Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review

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Asian Spine J. 2020;14(5):762-763
Publication date (electronic) : 2020 October 14
doi :
1Department of Neurosurgery, St. Vincent’s Hospital, Melbourne, VIC, Australia
2National Trauma Research Institute, Melbourne, VIC, Australia
3Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
Corresponding author: Tom O’Donohoe Department of Neurosurgery, St. Vincent’s Hospital, Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia Tel: +61-392312211, Fax: +61-292310077, E-mail:
Received 2020 August 22; Accepted 2020 August 31.

We were pleased to hear that the readers found our article to be interesting and relevant, and appreciate the opportunity to respond to their feedback [1].

Their primary concern was the restriction of included studies to those that directly compared combined anterior-posterior and posterior-only approaches, which resulted in the analysis of a relatively small number of dated studies. As has been recommended in a number of guidelines [2,3], our systematic review protocol was developed prior to conducting the study and we were unaware that only a small number of studies would be eligible for inclusion at the time of methodology development. Although less restrictive inclusion and exclusion criteria were considered, we believe that this is likely to have resulted in substantial heterogeneity among the included studies. When incorporated into a meta-analysis, study variability is widely accepted to have the capacity to influence the conclusions of a systematic review [2,3]. As such, it is possible, even likely, that the answer to the question raised by the readers—“Would this alternative search strategy have changed the outcome of this systematic review?”—is yes, which is why were so careful to include only comparative investigations as a means of ensuring relative homogeneity among included studies. Nevertheless, as observed by the readers, the findings of our review confirm that there is a paucity of data upon which to base judgements regarding the superiority, or otherwise, of combined anterior-posterior or posterior-only approaches in the management of traumatic thoracolumbar burst fractures and further research is required to improve upon our understanding of this important question.


No potential conflict of interest relevant to this article was reported.


1. Tan T, Donohoe TJ, Huang MS, et al. Does combined anterior-posterior approach improve outcomes compared with posterior-only approach in traumatic thoracolumbar burst fractures?: a systematic review. Asian Spine J 2020;14:388–98.
2. Higgins JP, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions version 6.0 [Internet]. Oxford: Cochrane Collaboration; 2019. [cited 2020 Aug 2]. Available from:
3. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:b2535.

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