A Comparative Study on Functional Recovery, Complications, and Changes in Inflammatory Factors in Patients with Thoracolumbar Spinal Fracture Complicated with Nerve Injury Treated by Anterior and Posterior Decompression

Abstract

BackgroundThe aim of this study was to evaluate 2 methods to treat patients with thoracic lumbar spine fracture with merging spinal cord injury, including complications of surgery and the influence of inflammatory factors.Material/MethodsEighty patients were randomly divided into an anterior decompression group (study group) or a posterior decompression group (control group) to observe perioperative complications, evaluate preoperative and postoperative nerve function, and evaluate the 6-month injured vertebral height and Cobb angle of the vertebral bodies. The expression level of TGF-β2 on day 1, day 7, day 15, and day 30 after treatment was detected by enzyme-linked immunosorbent assay (ELISA).ResultsThe nerve function sensation score, the height of the vertebral body, and the recovery of Cobb angle were better for the anterior decompression group than the posterior decompression group and the effect was significant (P<0.05). The complication rate for the posterior decompression group was lower than the anterior decompression group. The level of TGF-β2 in the anterior decompression group was higher than in the posterior decompression group for the same times: after day 1, day 7, day 15, and day 30 after treatment (P<0.05).ConclusionsPatients who had thoracic lumbar spine fracture with merging spinal cord injury and who had anterior fixation achieved a good fixation effect; their neurologic and vertebral injury recovery was better. However, this relatively complex and traumatic surgery must consider the clinical manifestations and fractures of the patients and select the appropriate surgical approach.

Comparison of Anterior and Posterior Decompressions in Treatment of Traumatic Thoracolumbar Spinal Fractures Complicated with Spinal Cord Injury

“…Anterior decompression the advantages of clear exposure during surgery, accurate decompression effect, small trauma, and fast fusion of factured vertebrae after surgery [ 20 ]. Compared with other similar research [ 7 , 11 , 15 ], the novelty of our study is that we showed anterior decompression effectually enhances the surgical outcomes, restores the physiological anatomy of fractured vertebrae, improves the postoperative nerve functions, and accelerates the recovery of urinary and sexual functions in patients with thoracolumbar spinal fractures complicated with spinal cord injury, which can improve their quality of life.…”

“…Thoracolumbar spine fracture with spinal injury and its complications, such as bilateral paralysis, urinary tract infection, and sexual dysfunction, have brought great pressure and economic burden to families and society. For these patients, timely surgery is the first choice [ 6 ], which includes anterior decompression and posterior decompression in terms of surgical approaches [ 7 ].…”

Surgical management of thoracolumbar junction fractures: An evidence-based algorithm

“…Furthermore, the requisite for a concomitant spinal decompression is still debated. Despite pieces of evidence reporting the lack of efficacy of anterior decompression or laminectomy in cases of neurological impairment, 27 , 28 , 29 , 30 , 31 our experience led to conclude conversely that decompression of the spinal canal ought to be performed in cases of neurological deficits and significant spinal encroachment, mostly more than 60%. This approach theoretically increases the likelihood of neurological recovery and prevents the onset of posttraumatic myelopathy and syringomyelia.…”

On the issue of predictors of complications of surgical treatment of patients with spinal cord injury in the lower thoracic and lumbar spine

“…Так, Jiang et al [19] сообщили о статистически значимо более высокой частоте осложнений при использовании передней декомпрессии из вентральных доступов (20 %), чем при использовании дорсальных вмешательств (9 %); p < 0,05. Аналогичные данные приводят в своем исследовании Stanсicćet al [20], в котором общая частота хирургических осложнений при выполнении вентральных операций составила 23,1 %, а при использовании операций из заднего доступа -8,3 %.…”