The Role of Combined Posterior and Anterolateral Retroperitoneal Approach in the Treatment of Posttraumatic Burst Lumbar Fractures.

Abstract

Context:Combined posterior and anterolateral retroperitoneal approach is very important for the treatment of unstable burst lumber fractures with retropulsed fragments.Aims:The aim of the study is to evaluate the role of combined posterior and anterolateral retroperitoneal approach in the treatment of unstable burst lumber fractures.Settings and Design:This is a retrospective clinical case series study.Patients and Methods:This study was conducted on 41 patients with unstable lumber burst fractures with retropulsed fragment. Frankel scale score and Denis pain score were used to evaluate the functional outcome. All patients were surgically treated using combined posterior and anterolateral retroperitoneal approach. They were followed for 1 year postoperatively.Statistical Analysis:Using SPSS version 21, data were presented as mean ± standard deviation, and percentage and paired sample and Wilcoxon signed-rank tests were used for data analysis.Results:the functional state of all patients improved after surgery. According to the Frankel and Denis pain scores, there was a significant improvement in patients’ scores postoperatively compared to preoperative ones (P = 0.001). Visceral manifestations were present in 16 cases (36.6%) with complete improvement postoperatively except two cases. There is a significant improvement as regards pre- and postoperative regional kyphotic angle (9.12 ± 10.03) and vertebral body height (3.14 ± 0.37). Unintended durotomy occurred in six cases treated by stitching using absorbable sutures and fat graft. Wound infection was present in two cases treated by antibiotics and daily dressing. A solid fusion was achieved in all cases.Conclusions:Combined posterior and anterolateral retroperitoneal approach is feasible and effective in surgical exposure and treatment of unstable burst lumber fractures with retropulsed fragments.