Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review

Abstract

Background Data: The management of unstable traumatic thoracolumbar fractures has shifted from more conservative treatment to more operative treatment modalities. Different surgical options have been reported in the literature. Purpose: To review two surgical techniques, anterolateral and posterior approaches, in management of thoracolumbar fractures and present a brief literature review. Study Design: A retrospective case series with review of the literature. Patients and Methods: Thirty patients were managed in the period from October 2012 to November 2016 for thoracolumbar burst fractures. Two patients’ groups were identified: Group I underwent anterolateral fixation and included 15 patients, whereas Group II underwent posterior fixation and included 15 patients. Follow-up was done at 3 months, 6 months, and one year postoperative using VAS for pain assessment and ASIA scale for neurological status evaluation. Radiological outcome involved the vertebral height restoration, spinal canal compromise, and kyphus deformity correction. Operative time, operative blood loss, and perioperative complications were all reported for both groups. Results: The most common spinal level affected in our study was L1 vertebra in 10 patients. Operative time and blood loss were found to be significantly less in the posterior approach. A significant improvement of VAS has been reported in both study groups with more improvement in the posterior group compared with the anterolateral one. 93.3% of anterior group patients within the showed either improved or fixed neurological status according to ASIA scale where, in posterior group, all patients showed either improved or fixed neurological status. The mean canal compromise percentage decreased in Group I from 69.3% preoperatively to 15.62% postoperative, whereas in Group II it decreased from 66.2% preoperative to 18.8%. Kyphotic angle has been corrected in posterior group from 13.42° preoperative to 11° at 6 months and 12.5° at one year, whereas in anterolateral group it has been corrected from 19.42° to 17.57° and 20.9°, respectively, with a statistically significant difference between both groups (P<0.01). Conclusion: Our data suggest that both anterior and posterior approach showed no difference in neurological outcome in patients with thoracolumbar fractures. However, anterior approach was superior to the posterior one in spinal canal compromise clearance and kyphotic angle correction. (2019ESJ174)

Keywords

• Anterolateral approach
• transpedicular
• angular deformity
• thoracolumbar fractures
• spinal canal diameter