Comparison of two Types of Surgery for Thoraco-Lumbar Burst Fractures: Combined Anterior and Posterior Stabilisation vs. Posterior Instrumentation Only

Abstract

This retrospective study compares clinical outcome following two different types of surgery for thoracolumbar burst fractures. Forty-six patients with thoracolumbar burst fractures causing encroachment of the spinal canal greater than 50% were operated on within 30 days performing either: combined anterior decompression and stabilisation and posterior stabilisation (Group 1) or posterior distraction and stabilisation using pedicle instrumentation (AO internal fixator) (Group 2). We evaluated: neurological status (Frankel Grade), spinal deformities, residual pain, and complications. The average follow-up was 6 years. There were no significant differences between the patients in both groups concerning age, sex, cause of injury and the presence of other severe injuries. Neurological dysfunction was present in 39% of all cases. Bony union occurred in all patients. Loss of reduction greater than 5 degrees and instrumentation failure occurred significantly more often in Group 2 compared to Group 1, but the kyphosis angle at late follow-up did not differ between groups, due to some degree of overcorrection initially after surgery in Group 2. The clinical outcome was similar in both groups, and all but one patient with neurological deficits improved by at least one Frankel grade. Indirect decompression of the spinal canal by posterior distraction and short-segment stabilisation with AO internal fixator is considered appropriate treatment for the majority of unstable thoracolumbar burst fractures. This is a less extensive surgical procedure than a combined anterior and posterior approach.

Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery

“…Until the 1990s, the focus of interest was mainly on posterior stabilization techniques [83], whereas anterior [21,38,40] and combined procedures [6,22,74] were spotlighted during the past two decades. This trend was reflected by the numbers from 1994 to 1996 MCSI and this study showing a continuous increase in combined surgery for TL-junction injuries from 34% (MCSI) up to 47% (MCSII).…”

Percutaneous kyphoplasty and pedicle screw fixation for the management of thoraco-lumbar burst fractures

“…Applying a single posterior osteosynthesis is known to involve the risk of secondary kyphosis, corresponding to an angle of 5°in 68% of the patients in a series studied by Been [2]. The loss of correction is most important when short-segment osteosynthesis is used, which is becoming increasingly common in the field of traumatology.…”

“…The treatment used to be purely conservative [1][2][3], but the risk of secondary neurological complications due to the occurrence of local kyphosis and the development of novel osteosynthetic materials have given rise to new surgical methods. Since the last decades various techniques have been described for the treatment of burst fractures with satisfactory results.…”

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

“…Although there is a varying consensus among treating physicians, surgical fixation of a traumatic fracture of the thoracic or lumbar spine is considered necessary if axial and rotational stability is severely impaired or if a neurologic deficit is present or imminent. Short-segment pedicle screw instrumentation is a well described technique to reduce and stabilize thoracic and lumbar spine fractures [3,4]. It is a relatively easy procedure but can only indirectly reduce a fractured vertebral body, and the means of augmenting the anterior column are limited.…”