Abstract
BackgroundNo consensus exists for the management of unstable thoracolumbar (TL) burst fractures. Surgical options include anterior, lateral, or posterior stabilization (or a combination), depending on the fracture. The potential benefits of anterior reconstruction come with increased operative time and associated morbidity. A posterior-only approach can offer stable correction without increased operative risks but may result in loss of kyphotic correction over time.PurposeTo determine whether posterior-only stabilization is a viable treatment option for patients with traumatic TL fractures as opposed to anterior and combined approaches.MethodsWe performed a retrospective analysis of adult patients with TL burst fractures who underwent posterior-only surgical intervention from 2005 to 2015. Operations were performed at two levels above and below the fractured segment using pedicle screw-rod fixation constructs with autograft and allograft. All patients received TL bracing for at least three months. Patients lost to followup were excluded.ResultsSixty-four consecutive patients with posterior-only stabilization were identified, with 18 lost to followup. Of the remaining 46 patients, 93% (n=43) were male and 7% (n=3) were female, with a mean age of 36.8 years. All patients were followed for 12 months. The mean time until the removal of the brace was 3.54 months. No patients required additional surgical intervention for spinal stabilization. Three patients experienced postoperative complications, all of which were related to infection.ConclusionsOur data indicate that posterior-only stabilization for traumatic TL burst fractures is a durable and effective option in select patients. The approach offers surgical intervention with a decreased perioperative risk as well as reduced morbidity and mortality, with a minimal increase in the risk of kyphotic deformity. Further prospective studies are necessary to validate these findings clinically.
Highlights
The optimal management of thoracolumbar (TL) fractures continues to be debated
Our data indicate that posterior-only stabilization for traumatic TL burst fractures is a durable and effective option in select patients
The goals of surgery are to fuse the fewest number of segments needed to obtain a well-balanced spine with lasting stability while reducing the risk of complications associated with large-scale operations
Summary
The optimal management of thoracolumbar (TL) fractures continues to be debated. While most patients are managed conservatively, surgery is indicated in patients whose the fracture mechanism and acquired traumatic deformity is deemed unstable. While anterior approaches may be superior for the correction of deformity, they are associated with longer operating times and increased blood loss [3]. Given that most patients with traumatic injuries of the spine have other associated injuries, the risks must be carefully weighed against the benefits when considering surgical management of TL instability. Lateral, or posterior stabilization (or a combination), depending on the fracture. The potential benefits of anterior reconstruction come with increased operative time and associated morbidity. A posterior-only approach can offer stable correction without increased operative risks but may result in loss of kyphotic correction over time. To determine whether posterior-only stabilization is a viable treatment option for patients with traumatic TL fractures as opposed to anterior and combined approaches
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