Clinical modification of the anterolateral approach for burst fractures of thoracolumbar spine

Abstract

Objective To discuss the modified anterolateral approach for the treatment of burst fractures of the thoracolumbar spine. Methods From April 2003 to September 2006, we treated 27 patients with burst fractures of the thoracolumbar spine. Sixteen of them were operated on through the L anterolateral approach modified out of the conventional thoraco-extraperitoneal approach using the space be-tween the erector spine muscles and quadratus lumborum muscles according to the anatomic relation of the thoracolumbar spine. The other 11 cases were treated through the conventional approach. The average blood loss for vertebral exposure, operation time and the total operation blood loss, as well as intraoperative and postoperative complications were compared between the 2 approaches. Results All the 27 cases had successful surgery. There were significant differences between the 2 approaches (P 0.05) in Cobb angle, height ratio of anterior borders of injured and normal vertebrae and neurological recovery. No serious complications were found in operation. After an average follow-up of 13 months, none of the patients had neurological deterioration, the spine recovered normal curvature and no implant failure happened. Conclusion The modified antero-lateral approach for the treatment of thoracolumbar spine burst fractures have the advantages of less invasion,less blood loss, effective decompression and maintenance of the spinal stability, and fewer complications. Key words: Thoracic vertebrae; Lumbar vertebrae; Burst fracture; Operative approach