Is It Necessary to Add Anterior Decompression after Posterior Decompression for Thoracolumbar and Lumbar Fractures with Neurologic Deficit?

ABSTRACT

STUDY DESIGN: A retrospective study. OBJECTIVES: To understand the necessity of additional anterior decompression when treating with posterior decompression for thoracolumbar and lumbar fractures, with neurologic deficit. SUMMARY OF LITERATURE REVIEW Additional anterior decompression is still a controversy after a posterior decompression. MATERIALS AND METHODS: We evaluated 38 patients who were treated with a decompression surgery for thoracolumbar and lumbar spine fractures with neurologic deficit. In the posterior decompression group, there were 26 patients, and there were 12 patients in the posterior and anterior decompression group. According to the Frankel grade, neurologic deficit was grade A 3, B 1, C 3, D 31, respectively. Unstable burst fractures were 22, flexion-distraction injuries 12, Chance fractures 2 and translational injuries 2 by the McAfee classification. Radiographic evaluation was carried out with comparison of the spinal canal encroachment and kyphotic angle. We evaluated the improvement of neurology, and compared with that of the preoperative canal encroachment. RESULTS: During the posterior decompression, 5 neural injuries were found in the post. decompression group, and 4 in the post. and ant. decompression group. There was no significant difference of neurologic improvement between the two groups (improvement in 18(69%) and 8(67%), respectively) (p>0.05). Preoperative canal encroachment was 62% and 76%, respectively. But, preoperative canal encroachment and final neurologic improvement showed no significant correlations between the two groups (p>0.05). CONCLUSIONS: We could not find the difference of neurologic improvement between the post. decompression group and post. and ant. decompression group. We suggest that an additional ant. decompression for the thoracolumbar and lumbar spine fractures treated with post. decompression is not necessary.