Significance of Anterior Support in Thoracolumbar Burst Fracture: Single Stage Interbody Fusion with Transpedicular Screw Fixation Versus Pedicle Screw Fixation with Lamina Onlay Fusion

ABSTRACT

OBJECTIVE: Surgical approaches to unstable burst fractures of the thoracolumbar spine are variable and include anterior decompression with interbody fusion and fixation, anterolateral approach and posterior approach. The purpose of this study is to compare the clinical and radiological results of single-stage interbody fusion with transpedicular screw fixation and pedicle screw fixation with lamina onlay fusion. METHODS: Thirty-five patients with thoracolumbar burst fractures were enrolled in the present study. The subject group was composed of 21 men and 14 women, with a mean age of 47.68+/-13.93 years(range, 19~76 years). Eighteen patients(Group I, anterior-posterior group) were treated with interbody fusion with transpedicular screw fixation with and 17 patients(Group II, posterior only group) were treated with pedicle screw fixation with onlay fusion. Both procedures were performed through single staged posterior approach. The neurological states, clinical outcomes and radiological outcomes were analyzed. Radiologic results were evaluated on the basis of kyphotic angle, percentage of anterior body compression and interbody height immediately after surgery and at the final follow-up examination. RESULTS: Kyphotic angle, anterior body compression rate and interbody height were corrected in both groups. While the correction was maintained in the patients in group I, kyphosis and anterior body compression rate were aggravated in the patients in group II at follow-up. Both groups showed the same or improved modified Frankel grades and pain scores. CONCLUSIONS: Group I showed better correction of kyphotic angle and percentage of anterior body compression than group II. Anterior column support plays an important role in maintaining the correction of kyphosis and this procedure can be effectively performed using single-stage unilateral posterior approach together with transpedicular screw fixation.