An Advanced Study on Anterolateral Approach for Unstable Lumber Burst Fracture with Anterior Compression

Abstract

Background: Lumbar burst fractures are common spinal injuries that cause severe instability with kyphotic deformities and neurological complications requiring surgical decompression and reconstruction with spinal instrumentation for unstable burst fracture, but there is controversy about the optimal surgical approach anterior, posterior or combined approach. The mechanism of retropulsion of bone fragments from the fractured endplates into the spinal canal is accepted by many to be the high energy transferred to the vertebral body during major trauma leading to increased risks of neurological complications and kyphotic deformities. Objectives: To assess the efficacy & safety of anterolateral approach in decompression and reconstruction with spinal instrumentation for lumbar burst fractures. Subjects & Methods: A retrospective study including 16 patients, 10 males and 6 females with lumbar burst fractures and anterior compression treated operatively by anterolateral approach for corpectomy and single level fusion by using expandable cage or mesh cage loaded with bone graft and plat with screws. The clinical and radiological follow up after discharge from the hospital ranged from 12 to 24 months. Results: All patients improved regarding the Frankel score more than one grade after surgery, except 2 cases of grade A didn’t improve. Mean preoperative visual analogue scale was 7.4 improving to 0.9 postoperatively. The mean Local kyphosis improved from 8.8° before surgery to ?1° after surgery. Conclusions: Anterolateral approach is feasible, effective, and safe approach for unstable lumbar burst fractures. Angular deformity is successfully corrected when the anterior approach is used. Corpectomy with anterior approach and grafting is an effective treatment modality. Anterior approach not only provides successful correction of angular deformity by reconstruction of anterior and middle columns with fusion, but also it helps to improve the neurological status in patients with neurological deficits by safe and efficient decompression of the spinal canal. All of these are approved by our results.