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Anterior versus posterior surgical treatment of unstable thoracolumbar burst fracture

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

This retrospective study compares clinical outcomes of anterior versus posterior surgery for treatment of unstable thoracolumbar fracture.

Methods

Retrospective analyses of 96 patients with unstable thoracolumbar fracture of one vertebral body (T11–L2) treated by surgery. Fifty-one patients had anterior surgery (AG), and 45 had posterior surgery (PG). Neurological function outcome was evaluated by American Spinal Injury Association (ASIA) classification, and Short Form-36 (SF-36) health survey was used to evaluate both physical and mental status of patients. Sagittal and coronal Cobb angle, canal compromise, and fusion rate were evaluated on radiographic film.

Results

There were no intraoperative deaths, and no patient experienced neurological deterioration. After surgery, neurological function as measured by Frankel grade improved on average 0.961 in AG and 0.956 in PG. Clearance rate of encroachment and canal compromise at final follow-up were significantly better in AG than in PG (P < 0.001). At long-term follow-up, loss of sagittal correction was more severe in PG than in AG (P < 0.01). However, coronal plane deformity correction was better in PG than in AG (P < 0.001). SF-36 physical functioning (PF), role limitations due to physical health (RP), and social functioning (SF) scale values were higher in AG than in PG (P < 0.001), and role limitations due to emotional problems (RE) scale value was higher in PG than in AG (P < 0.05). There were no complications and no metal failure in AG, and two complications of PG with pseudarthroses were identified on radiographic analyses (one case of screw breakage and one case of screw loosened).

Conclusions

Anterior and posterior surgery are reliable procedures with good outcome in unstable thoracolumbar fracture. Anterior surgery showed superior results regarding postoperative canal compromise, loss of sagittal alignment, and complications, but posterior surgery had shorter surgery time, less blood loss, and shorter hospital stay, and ultimately no difference in neurological improvement.

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Acknowledgments

The authors thank Dr. Lijun Duan for her help with statistical analysis.

Conflict of interest

The authors state that there are no conflicts of interest. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of the article.

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Authors and Affiliations

  1. Orthopaedics Department, Baoan People’s Hospital, Shenzhen, 518101, People’s Republic of China

    Denglu Yan

  2. Orthopedics Department, Fifth Affiliated Hospital of Zunyi Medical College, Zhuhai, 519100, People’s Republic of China

    Zhaojie Wang

  3. Orthopedic Department, Third Hospital of Guangzhou Medical College, Guangzhou, 510150, People’s Republic of China

    Yuming Lv & Jian Li

  4. Orthopedics Department, Shilou People’s Hospital, Guangzhou, 519100, People’s Republic of China

    Bulin Baiyila

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  1. Denglu Yan
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  2. Zhaojie Wang
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Correspondence to Denglu Yan.

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Yan, D., Wang, Z., Lv, Y. et al. Anterior versus posterior surgical treatment of unstable thoracolumbar burst fracture. Eur J Orthop Surg Traumatol 22, 103–109 (2012). https://doi.org/10.1007/s00590-011-0775-0

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  • DOI: https://doi.org/10.1007/s00590-011-0775-0

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