Analysis of surgical approaches for unstable thoracolumbar burst fracture: minimum of five year follow-up

ABSTRACT

To evaluate and compare the long-term outcome of unstable thoracolumbar burst fractures treated using anterior, posterior or combined anterior and posterior approaches. The prospective randomised controlled study was conducted at the Tianjin 4[th] Centre Hospital, Tianjin, China, and comprised patients of unstable thoracolumbar burst fracture operated between July 2004 and July 2006 and followed up for five years. The patients were divided randomly into three groups of anterior, posterior and combined anterior and posterior approaches. Clinical data was analysed using SPSS 17. Of the 66 cases in the study, 45[68.18%] were male and 21[31.8%] were female, with overall age ranging from 19 to 69 years. There were 22[33.3%] patients in the anterior group, 23[35%] in the posterior group, and 21[32%] in the combined anterior and posterior group. Comparison was made between two respective groups. The combined group was found to have the longest operation time [p<0.02; p<0.01, respectively], larger blood loss [p<0.006; p<0.005, respectively], longer hospital stay [p<0.01; p<0.003, respectively] and higher hospitalisation costs [p<0.004; p<0.001, respectively]. The postoperative kyphotic angle was significantly smaller than preoperative one in all groups [p<0.01; p<0.02; p<0.01]. The anterior approach or combined anterior and posterior approach were better options in managing unstable thoracolumbar burst fracture, while the latter should be used only for the burst fracture with a significant posterior column injury