Lateral position one-stage combined anteroposterior approach versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures

Abstract

To compare the medium and long-term outcomes of lateral position one-stage plus anteroposterior versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures. A total of 47 patients with thoracolumbar burst fractures were divided into 2 groups according to surgical approaches. Group A underwent lateral position one-stage plus anteroposterior approach while group B had posterior approach with subtotal corpectomy, decompression and reconstruction of spine. During a follow-up period of 36-68 months, their clinical and radiological outcomes were retrospectively evaluated. The perioperative volume of blood loss, operative duration, complications, pulmonary functions, Frankel scale and American Spinal Injury Association (ASIA) motor scores were recorded and analyzed. And the heights of anterior edge of vertebral body and Cobb angle were examined for radiological outcomes. At the latest follow-up, all patients achieved solid fusion with significant neurological improvements. The perioperative volumes of blood loss were less, operative duration was shorter and postoperative pulmonary functions were better in the group B (P < 0.05). The ASIA motor score and radiological outcomes were not significantly different at all timepoints between two groups (P < 0.05). But the neurological functions of two groups improved by approximately 1.4 Frankel grade (group A) versus 1.41 (group B) at the final follow-up. Lateral position one-stage plus anteroposterior and posterior approaches with subtotal corpectomy, decompression, and reconstruction of spine are adequate surgical treatments for thoracolumbar burst fractures. But the latter has the major advantages of less perioperative volume of blood loss, fewer complications, shorter operative duration and better pulmonary functions.