The Surgical Management of Unstable Thoracolumbar Burst Fractures with Anterolateral and Posterior Approach: Comparison of Clinical and Radiological Outcome

Abstract

Objective: The authors evaluate the clinical and radiographic outcome of the management of acute thoracolumbar burst fractures by anterolateral or posterior approach. Methods: Thirty four (34) consecutive patients with a single-level traumatic unstable burst fracture at the thoracolumbar junction were surgically treated between Jan. 2004 and Dec. 2006. Twenty one patients were operated on by anterolateral approach, strut graft and fixation with a Kaneda plate. Thirteen patients were treated with posterior approach and transpedicular screw fixation. Clinical and radiographic evaluation was performed on all 34 patients before and after surgery. Results: There were 34 thoracolumbar burst fractures in 27 male and 7 female patients. Fifty-nine percent (20 of 34) of patients presented with a neurologic deficit. The mean follow-up duration was 18.5 months (range 7-44 months). Preoperative canal encroachment in the anterolateral and posterior groups measured 49.3±7.6%, 27.3±9% respectively (p=0.001). Preoperative angular deformity in the anterolateral and posterior groups measured 19.4±8.4° and 12.9±4.5° respectively. At discharge, angular deformity had been corrected to 10.5± 7.3° and 7.6±4.9° in both groups, respectively. Preoperative Frankel grade grade in the anterolateral and posterior groups was 3.9±1.2, 3.9±1.5 respectively (p=0.9). Postoperatively, it had been improved to 4.4±1.1, 4.2±1.4 in both groups, respectively. Conclusion: Compared with posterior approaches, the anterolateral approach can reduce fusion segment, well maintained the kyphosis correction and decompress the spinal canal completely. The selection of treatment should be based on clinical and radiological finding including neurological deficit. (J Kor Neurotraumatol Soc 2008;4:37-42)