Comparison of three different surgical approaches for treatment of thoracolumbar burst fracture

Abstract

【Abstract】Objective: The main treatment method used for thoracolumbar fractures is open reduction and in-ternal fixation. Commonly there are three surgical approaches: anterior, posterior and paraspinal. We attempt to compare the three approaches based on our clinical data analysis. Methods: A group of 94 patients with Denis type A or B thoracolumbar burst fracture between March 2008 and September 2010 were recruited in this study. These patients were treated by anterior-, posterior- or paraspinal-approach reduction with or without decompression. The fracture was fixed with titanium mesh and Z-plate via anterior approach (24 patients), screw and rod system via posterior approach (38 patients) or paraspinal approach (32 patients). Clinical evaluations included operation duration, blood loss, inci-sion length, preoperative and postoperative Oswestry dis-ability index (ODI). Results: The average operation duration (94.1 min±13.7 min), blood loss (86.7 ml±20.0 ml), length of incision (9.3 mm± 0.7 mm) and postoperative ODI (6±0.5) were signifi-cantly lower (P<0.05) in paraspinal approach group than in traditional posterior approach group (operation duration 94.1 min±13.7 min, blood loss 143.3 ml±28.3 ml, length of incision 15.4 cm±2.1 cm and ODI 12±0.7) and anterior approach group (operation duration 176.3 min±20.7 min, blood loss 255.1 ml±38.4 ml, length of incision 18.6 cm±2.4 cm and ODI 13±2.4). There was not statistical difference in terms of Cobb angle on radiographs among the three approaches. Conclusion: The anterior approach surgery is conve-nient for resection of the vertebrae and reconstruction of vertebral height, but it is more complicated and traumatic. Hence it is mostly used for severe Denis type B fracture. The posterior approach is commonly applied to most thora-columbar fractures and has fewer complications compared with the anterior approach, but it has some shortcomings as well. The paraspinal approach has great advantages com-pared with the other two approaches. It is in accordance with the concept of minimally invasive surgery and can re-place most posterior approach operations. Key words: Thoracic vertebrae; Lumbar vertebrae; Fractures, bone; Surgical procedures, operative; Spine