Anterior Approach Versus Posterior Approach With Subtotal Corpectomy, Decompression, and Reconstruction of Spine in the Treatment of Thoracolumbar Burst Fractures

Abstract

STUDY DESIGN: A randomized, controlled follow-up study. OBJECTIVE: The objective of this study was to compare the results of anterior approach versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: Burst fractures are frequently associated with instability or neurological deficit. Anterior subtotal corpectomy, decompression, and reconstruction with instrumentation are an established method for a highly unstable burst fracture. In the past few years, subtotal corpectomy, decompression, and reconstruction of spine could be completed by posterior approach. Posterior segmental pedicle screw instrumentation, with its more rigid fixation and less technically demanding, could offer potential advantages. METHODS: A total of 64 patients with thoracolumbar burst fractures were divided into 2 groups randomly. Group A was treated by anterior approach and group B was treated by posterior approach with subtotal corpectomy, decompression, and reconstruction of spine. During the minimum 24 months (range, 24 to 72 mo) follow-up period, all patients were prospectively evaluated for clinical and radiologic outcomes. The intraoperative blood loss, operative time, complications of operation, pulmonary function, Frankel scale, and the American Spinal Injury Association (ASIA) motor score were used for clinical evaluation, whereas the heights of anterior edge of vertebral body and the Cobb angle were examined for radiologic outcome. RESULTS: All patients in this study achieved solid fusion, with significant neurological improvement. The intraoperative blood loss (P<0.05) and complications of operation were less, the operative time was shorter (P<0.05), and the pulmonary function after operation was better in the group B (P<0.05). The Frankel scale, the ASIA motor score, and the radiologic results were not significantly different (P<0.05) at all time points between the 2 groups A and B. But the 2 groups improved in their neurological function by approximately 1.3 Frankel grade and 15.6 ASIA motor scores at final follow-up. CONCLUSION: Anterior approach and posterior approach with subtotal corpectomy, decompression, and reconstruction of spine are sufficient for surgical treatment of thoracolumbar burst fractures. Less intraoperative blood loss and complications, shorter operative time, and better pulmonary function after operation are the significant advantages of posterior surgery.

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

“…On critical evaluation of the included trials, we found that Lin et al [29] reported many more complications in the anterior approach group than in the posterior group, including twenty-seven cases of hemopneumothorax, two cases of respiratory tract infection, three cases of intercostal neuralgia and thirteen cases of abdominal distension and constipation. In the study conducted by Wood et al [26], there were seventeen ''events'' in the posterior approach group, including six cases of instrument removal, two cases of wound dehiscence, two cases of instrumentation/bone failure, two urinary tract infections, two cases of instrument breakage, one deep wound infection, one case of pseudarthrosis and one case of seroma.…”

“…4). In addition, Lin et al [29] did not find a significant difference between the anterior and posterior approach groups.…”

“…There was significant heterogeneity (I 2 = 97 %) among the studies; however, this disappeared after the exclusion of two studies (Lin et al [29] and Wood et al [26]; I 2 = 3 %, Fig. 9).…”

“…Figure 1 shows a flow chart of the study selection and inclusion process. The search strategy identified 679 citations, of which seven satisfied the pre-defined inclusion criteria for data extraction and meta-analysis [23][24][25][26][27][28][29] (Table 1). These studies involved 179 patients in the anterior approach group and 152 patients in the posterior approach group.…”

“…We could not use the information from the study by Lin et al [29], because we used the improvement in Frankel scores (by one or more grades) to calculate the effects of the two surgical approaches. No significant differences were detected between the anterior and posterior approach groups (RD, 0.06; 95 % CI -0.07 to 0.19; P = 0.38; Fig.…”