Anterior Versus Posterior Approach in the Treatment of Chronic Thoracolumbar Fractures

Chen, Zhi wen; Ding, Zi-Niu; Zhai, Wen; Lian, Ke jian; Kang, Liang qi; Guo, Lin; Liu, Hui; Lin, Bin

doi:10.3928/01477447-20120123-05

Cited by 9 publications

(7 citation statements)

References 42 publications

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“…Patients with posttraumatic thoracolumbar kyphosis present with a variety symptoms, including local muscle fatigue or pain, focal deformity, and neurological deficits. 7,9,13,29,31 Therefore, pain intractable to conservative treatment, progressive deformity, or progressive neurological deficits are the main indications for surgical intervention.…”

mentioning

confidence: 99%

Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis

Jo¹,

Kim²,

Kim³

et al. 2015

SPI

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OBJECT Most thoracolumbar fractures have a good healing outcome with adequate treatment. However, posttraumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment, osteoporosis, or osteonecrosis of the vertebral body. There are several surgical options to correct posttraumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of success. The aim of this study was to assess the use of a modified closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated using this technique. METHODS Thirteen consecutive patients with symptomatic posttraumatic thoracolumbar kyphosis were treated using a modified closing wedge osteotomy. The mean patient age was 62 years. The kyphosis apex ranged from T-10 to L-2. The sagittal alignment, kyphotic angle, neurological function, visual analog scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up. RESULTS The mean preoperative regional angle was 27. 4°, and the mean correction angle was 29. 6°. Sagittal alignment improved with a mean correction rate of 58. 3%. The mean surgical time was 275 minutes, and the mean intraoperative blood loss was 1585 ml. The intraoperative complications included 2 dural tears, 1 nerve root injury, and 1 superficial wound infection. The mean visual analog scale score for back pain improved from 6. 6 to 2, and the Oswestry Disability Index score decreased from 55. 4 to 22. 6 at the last follow-up. All patients achieved bony anterior fusion based on the presence of trabecular bone bridging at the osteotomy site. CONCLUTIONS The modified posterior closing wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and fewer complications. It is an alternative method for treating patients with posttraumatic thoracolumbar kyphosis.

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mentioning

confidence: 99%

Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis

Jo¹,

Kim²,

Kim³

et al. 2015

SPI

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“…Chen et al, 11 in their review of 36 patients of chronic T-L fractures, opined that hemothorax, abdominal distension, and constipation were fewer in posterior approach; postoperative pulmonary function and correction of kyphosis were better in posterior approach (p < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Dilemma of Approaches to Thoracic and Lumbar Spine: Our 10 Years' Review

Datta

Barman

Varshney

et al. 2015

Indian Journal of Neurosurgery

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Background?Lesions of the thoracic and lumbar spine are numerous. These lesions affect one or more columns (anterior, middle, and posterior) of the spine and compress the spinal cord either from anterior or posterior, giving rise to the features of radiculomyelopathy. These lesions can be approached either from the anterior or posterior aspect of the spine. We present our past 10 years' experience regarding the comparison between the two approaches. Methods?Retrospective analysis of records of all patients with thoracic and lumbar lesion treated in our hospital between January 2005 and June 2014 was performed. Over the past 10 years, we came across 186 patients of thoracic and lumbar lesion who were operated either by anterior or posterior approach and were the focus of this study. Follow-up ranged from 6 months to 7 years. Results?All the patients presented with neurological deficits. They were evaluated with investigation protocol of our hospital. Anterior approach was done in 38 cases (n?=?38), and posterior approach was done in 148 cases (n?=?148). We compared between the two groups in terms of perioperative complications, recovery, persisting symptoms, and mortality. Conclusion?Complete recovery is better in the posterior approach (74.3 vs. 52.6%) and morality is more in the anterior approach (7.9 vs. 1.3%).

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“…In long instrumentations, besides larger-scale surgery, the patient loses more mobile segments of the spine due to the fixation. 16,17 An important point of this work is that the fixation included the fractured vertebra, which distributes the load applied on the implant material. The Load Sharing classification, in its original article, did not take into account the intermediate fixation of the fractured vertebra.…”

Section: Discussionmentioning

confidence: 99%

Review of McCormack Classification for Thoracolumbar Segment Fractures

et al. 2017

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Objective: The aim of this study was to evaluate the success and complications rates of thoracolumbar fractures with a score equal or superior to 7 according to the load sharing classification (McCormack), surgically treated with short posterior fixation at three points. Methods: We evaluated 40 patients with thoracolumbar fractures and score by the load sharing classification greater than or equal to 7, treated exclusively by surgery by short posterior fixation. We assessed epidemiological data, increased kyphosis, loss of vertebral body height and complications at 2-year follow-up. Results: Although there was a statistically significant increase in kyphosis and a decrease in vertebral height, there was no clinical repercussion. Conclusion: We conclude that the McCormack classification is not a fundamental predictor for indication of anterior approach complementary to the short posterior fixation.

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Anterior Versus Posterior Approach in the Treatment of Chronic Thoracolumbar Fractures

Cited by 9 publications

References 42 publications

Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis

Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis

Dilemma of Approaches to Thoracic and Lumbar Spine: Our 10 Years' Review

Review of McCormack Classification for Thoracolumbar Segment Fractures

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