Comparison of the clinical effect between anterior and posterior vertebral resection/reconstruction for treatment of old thoracolumbar compression fracture complicated with kyphosis

Abstract

Objective To compare the clinical effect between anterior and posterior vertebral resection/ reconstruction for treatment of old thoracolumbar compression fracture combined with kyphosis. Methods From January 2003 to December 2012, 41 patients of old thoracolumbar vertebral compression fracture with kyphosis were retrospectively reviewed. Twenty patients underwent anterior corpectomy and fixation (ACF) and 21 patients undwent posterior unilateral vertebral column resection (PUVCR). Clinical evaluation: operative time, blood loss, Oswestry disability index (ODI), pain relief (visual analog scale, VAS). Radiographic evaluation: kyphosis correction, loss of correction, titanium subsidence, titanium tilt, fixation-related complications, fusion and incidence of heterotopic ossification. Results The surgery time was shorter in PUVCR group[(168.3±8.9)min] than that in ACF group[(184.3±8.1)min], the blood loss was less in PUVCR group[(845.7±85.3)mL] than that in ACF group[(974.5±76.1)mL], the differences were statistically significant(t=6.002, 5.091, all P values 0.05) and pain relief (t=0.311, P>0.05) did not show significant differences at one year of follow-up. The kyphosis correction was larger in PUVCR group(37.1°±4.4°) than that in ACF group(22.3°±5.4°) (t=9.687, P 0.05). There were no significant differences in titanium mesh subsidence (t=0.502, P>0.05), titanium tilt on AP-X ray (t=1.535, P>0.05), titanium tilt on Lateral-X ray (t=0.968, P>0.05) between PUVCR and ACF group on one year follow-up. No severe neurovascular complication occurred in both groups, and all the patients achieved satisfactory bone fusion on one year follow-up without pseudarthrosis and fixation complications. Complications included 1 patient of intraoperative intraperitoneal rupture and five patients of persistent bloating in ACF, 1 patient of wound delayed healing in PUVCR postoperatively. Conclusions PUVCR is superior in kyphosis correction, operation time shortening and blood loss decreasing, however, the surgical planning should consider the surgeon′s experience and preference. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Fractures, compression; Kyphosis; Osteotomy