Treatment of Thoracolumbar Burst Fractures by Means of Anterior Fusion and Cage

Abstract

Retrospective case series. To evaluate the outcome of treating acute thoracolumbar burst fractures using anterior corpectomy and reconstruction with a mesh cage and instrumentation. There is increasing interest in using an anterior mesh cage with instrumentation after corpectomy for burst fractures. However, there is only limited information on this technique in the literature. Twenty-two patients (mean age 37.6 y old) that had sustained a thoracolumbar burst fracture were included in this study. On admission, 20 patients (90.9%) had an incomplete neurological deficit. An anterior thoracolumbar approach was used to perform anterior corpectomy and reconstruction with a mesh cage and lateral fixation with screws and dual rods. We studied the operation date and delayed the blood loss, and we used the American Spinal Injury Association grade to evaluate the neurological status before surgery and in the follow-up period. Local kyphosis measured by the Cobb method was compared before and after the surgery using Wilcoxon signed-rank test/2-tailed test for analysis. Ninety percent of patients were operated within 2 days after admission and all were followed for a minimum of 25 months. The mean follow-up period was 47.4 months (range, 25 to 71 mo). Blood loss averaged 1445 mL. Of the 20 patients with incomplete neurological lesions, there were 6 (30%) patients with an improvement of at least 1 American Spinal Injury Association grade. No neurological deterioration was observed in any case. The local kyphosis measured by the Cobb method was improved from a mean of 15 degrees preoperative to a mean of 9.6 degrees in early postoperative period (P=0.002). The mean after 2 years was 11.5 degrees (P=0.011). There was no instrumentation failure. Anterior thoracolumbar decompression and fusion secured with an anterior mesh cage and instrumentation in thoracolumbar burst fractures provided excellent immediate reduction of post-traumatic local kyphosis.