Anterior thoracolumbar locked plate fixation for the treatment of an acute unstable burst fracture of the thoracic and lumbar spine

Abstract

Background In unstable burst fractures of the thoracic and lumbar spine, short segmental posterior fixation has been associated with a high rate of hardware failure, with recurrence of deformity. Anterior surgical treatment allows direct decompression of the neural elements and reconstruction of the weight-bearing column with fusion of only two levels. Aim of the work The aim of this study was to evaluate the effectiveness of anterior-only surgery and locked plate fixation in the treatment of unstable burst fractures of the thoracic and lumbar spine. Study design Prospective study. Patients and methods We included 22 patients (13 men and nine women) with acute thoracolumbar burst fractures treated with anterior surgery, strut iliac graft, and fixation with a locked thoracolumbar plate. The mean age of the patients at the time of surgery was 33.2 years (range 19–55 years). Neurologically, five patients were Frankel B, 13 were Frankel C, and four were Frankel E. All patients had preoperative and postoperative radiographs and computed tomography scan. Results The 18 patients with neurological deficit showed at least one Frankel grade improvement on final observation, with 16 (88.9%) patients showing complete neurological recovery. Sagittal alignment was improved from a mean preoperative kyphosis of 19.9–6.7π at the final observation. Conclusion Through the anterior surgery of the spine and locked plate fixation, we can achieve good canal decompression, spinal column alignment, and short segment arthrodesis.