[Impact of surgical strategy on quality of life and radiological outcome in traumatic fractures of the thoracolumbar spine]. / Einfluss des Operationsverfahrens auf Lebensqualität und Korrekturverlust bei traumatischen Wirbelkörperfrakturen des thorakolumbalen Übergangs.

BACKGROUND: There are a variety of surgical strategies for the treatment of traumatic thoracolumbar vertebral fractures. There is still no proof for the superiority of any strategy concerning clinical or radiological outcomes. The aim of this study was the evaluation of residual complaints and correlation with radiological findings. PATIENTS AND METHODS: 87 patients, who underwent different types of surgery for vertebral fractures of the thoracolumbar region were included. Patients were treated by posterior stabilisation with internal fixation alone, by a combined approach using posterior internal fixation and anterior fusion by bone graft from the iliac crest with or without additional anterior plating or with a combined approach using posterior stabilisation and anterior implantation of an expandable titanium cage. Data were collected using results of physical examination, standardised testing of several established quality of life scores (SF-36, VAS, LBOS and Oswestry score) as well as radiological findings (post-traumatic kyphosis, loss of correction). RESULTS: There was no difference in the overall results of quality of life in the different subgroups. Analysis of the subgroups revealed differences in the complaints according to the surgical strategy used (a high rate of non-fusion where bone grafts, especially without additional anterior plating were used, combined with a high rate of bone graft morbidity, intercostal neuralgia in cage implantation). Loss of correction as documented in the radiological course showed a maximum in patients who underwent posterior stabilisation without an additional anterior approach. There was no correlation of loss of correction and quality of life. CONCLUSION: Overall outcomes of the four surgical strategies were comparable in our study concerning loss of correction and quality of life, respectively. The use of bone grafts, however, results in a high rate of non-fusion with a remarkable number of patients complaining about bone graft morbidity. Therefore we prefer the use of expandable titanium cages for anterior stabilisation if additional anterior stabilisation is necessary due to type of fracture or damage of adjacent discs. In any other cases, a limited approach by posterior instrumentation alone should be considered.