Anterior approach surgery for Denis type B thoracolumbar burst fractures in adults

Abstract

Objective To investigate the effect of anterior surgery for Denis type B thoracolumbar burst fractures in adults.Methods Twenty-eight patients with Denis type B thoracolumbar burst fractures combined with partial neurologic deficit underwent anterior surgery between July 2007 and December 2012.Clinical evaluation comprised Oswestry disability index (ODI),American spinal injury association (ASIS),and visual analogue scale (VAS).Radiological measurements included kyphosis Cobb' s angle,anterior vertebral body height,and canal stenosis index.Results Mean duration of follow-up was 37.7 months.Canal stenosis index improved from preoperative 45.4％ to 3.8％ at final follow-up (P ＜ 0.05).All patients showed obvious improvements in clinical and neurological symptoms function at final follow-up.Mean kyphosis Cobb angle improved from preoperative 22.9°to 10.4° at final follow-up (P ＜ 0.05).Mean anterior vertebral body height improved from preoperative 30.3 mm to 38.7 mm.ODI and VAS presented 38.4-and 7.3-point improvements respectively and both were not statistically different after operation and at final follow-up.ASIS motor and sense scores presented no statistical variations before and after operation,but separately increased by 23.0 points and 30.7 points at final follow-up (P ＜ 0.05).No implant failed.Conclusion Anterior approach provides direct access for repair of the fracture,complete decompression of the vertebral canal,correction of kyphotic deformity,short-level fusion,and early rehabilitation. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal ; Anterior approach