Comparison of three methods of bone grafting in the treatment of thoracolumbar burst fracture

Abstract

Objective To compare and the advantages and disadvantages of 3 methods of bone grafting in the posterior treatment of thoracolumbar burst fracture. Methods A retrospective analysis was conducted of 258 thoracolumbar burst fractures treated with posterior short-segment fixation from March 2013 to March 2015 at Orthopedic Department One, Foshan Hospital of Traditional Chinese Medicine. Of them, 87 were treated with transpedicular bone grafting (group A), 87 with laminar and intertransverse process bone grafting (group B) and 84 with small joint turnover plus bone grafting (group C). The 3 groups were compared in terms of cobb angle, loss of correction, bony fusion, internal fixation failure, and Oswestry disability index (ODI). Results The 3 groups were comparable due to insignificant differences in the preoperative general data between them (P>0.05). The cobb angles in the 3 groups at one week after operation (4.9°±1.0°, 4.8°±0.6° and 4.8°±0.6°) and at the final follow-up (6.1°±1.5°, 14.5°±3.7° and 15.3°±4.1°) were significantly smaller than those before operation (27.5°±4.9°, 27.6°±4.6° and 27.6°±4.2°) (P<0.05). The cobb angles in groups B and C at the final follow-up were significantly larger than those at one week after operation (P<0.05). At the final follow-up, both the cob angles and the loss of kyphoplasty correction in groups B and C were significantly larger than in group A (P<0.05). The fusion rate in group A (100%) was significantly larger than in group B (80.5%) and C (76.2%). There were no significant differences between the 3 groups in the rate of internal fixation failure (0, 1.1% and 2.4%) (χ2=2.108, P=0.348). The ODI for the 3 groups at 6 months after operation (28.5±4.1, 28.7±3.9 and 28.8±3.7) and at the final follow-up (10.7±2.6, 11.0±2.7 and 11.4±3.1) were all significantly lower than the preoperative values (94.3±0.7, 94.4±0.9 and 94.4±0.8) (P<0.001). In all the patients, the ODI at the final follow-up was significantly lower than that at 6 months after operation(P<0.001). Conclusions In the treatment of thoracolumbar burst fractures, all the posterior approach plus transpedicular bone grafting, posterolateral bone grafting and reversed bone grafting plus short segmental internal fixation can effectively restore vertebral height and result in a high rate of fusion. Although the latter 2 methods of bone grafting are effective, they may be disadvantageous in leading to long-term loss of vertebral height and kyphosis correction. Key words: Thoracic vertebrae; Lumbar vertebrae; Fractures, bone; Bone graft