Comparison of antero-posterior and anterior approaches for unstable thoracolumbar fractures / 中华创伤骨科杂志

ABSTRACT

Objective To compare the clinical efficacy of anteroposterior approach (APA) versus anterior approach (AA) for decompression,fusion and fixation for single-level unstable thoracolumbar vertebrae fractures concomitant with incomplete neurologic symptoms and injury to posterior ligament complex (PLC).Methods From February 2006 to June 2012,55 patients were treated for single-level unstable thoracolumbar vertebrae fractures.Of them,27 were treated by only anterior decompression and lateral screw-rod instrumentation and 28 by anterior decompression and fusion combined with open posterior pedicle fixation of one to two segments above and below the fracture position.The 2 groups were compared at postoperative 3 and 12 months in terms of visual analogue scale (VAS),overall score of short-form health survey (SF-36),Japanese Orthopaedics Association (JOA) score of lower back,Oswestry disability index (ODI),loss ratio of anterior margin of vertebral height,endplate angle of kyphotic deformity of superior-inferior adjacent vertebrae,wedge angle of fractured vertebra via radiographic measurement and canal compromise rate.The neurologic functional recovery was analyzed using the American Spine Injury Association (ASIA) evaluation system at postoperative 12 months.Results There were no significant differcnces in operative time,amount of blood loss or postoperative drainage between the 2 groups (P ＞ 0.05).At postoperative 3 months,the VAS and JOA scores in the APA group were significantly better than those in the AA group (P ＜ 0.05).At 12 months after surgery,the VAS,kyphotic angle of adjacent vertebra,wedge angle of fractured vertebra and the ASIA improvements in the APA group were significantly better than those in the AA group (P ＜ 0.05).There were no significant differences between the 2 groups in the other indexes at postoperative 3 or 12 months (P ＞ 0.05).All the comparative indexes were significantly improved than the preoperative values in all the patients in the 2 groups at both 3 and 12 months (P ＜ 0.05).Conclusions Compared with the merely anterior approach,the combined antero-posterior approach may have advantages of better immediate and persistent reduction,steadily rebuilding fractured alignment,continuously maintaining injured biomechanical stability,and obviously improving neurological function.As the antero-posterior approach allows for combination of posterior auxiliary reduction and fixation with anterior definitive support and decompression,it may lead to a safe and effective treatment of unstable single-level thoracolumbar fracture concomitant with incomplete neurologic and PLC impairments.