The Choice Of Anterior Or Posterior Approach Surgery For The Treatment Of Thoracolumbar Burst Fractures

Objective : To analyze the anterior or posterior surgical treatment of thoracolumbar burst fracture of the efficacy and indications.Methods : Retrospective analysis in 2003.7 -2006.7, surgical treatment of 95 cases of thoracolumbar burst fracture. There were 72 males and 23 females the age of the patients were from 18 to 56 years with an average of 36.8 years. Segmental fracture : T₁₁ 10 cases, T₁₂ 26 cases, L₁ 41 cases and L₂ 18 cases. According to Denis classification:type A 22 cases , and type B 36 cases, type C 16 cases, type D 12 cases, type E 9 cases. There were 45 cases received posterior surgeries and 50 cases received anterior surgeries. ASIA standard using assessed spinal nerve function recovery. Through Radiological examination heights of the anterior and posterior edge of fractured vertebrae and the Cobb,s angle for preoperative situation, Surgical correction and the lost in follow-up , decompression of spinal canal and fusion rate.Results: 95 patients were followed—up for 6 to 48 months average 12months. There were no severe postoperative complications, such asdeterioration of nerve function. In the posterior surgeries, pedicle screwsbroken in 2 cases. All of the 87 patients who had preoperative incompleteparaplegia whose neurological status improved 1.2 ASIA grade in anteriorsurgeries cases and 1.1 ASIA grade in posterior surgeries cases. In theanterior surgeries: In preoperative, heights of the anterior and posterioredge of fractured vertebrae and the Cobb,s angle were (39.8%±10.3%)(72.5%±10.1%) and (24.7°±7.4°) ,in Postoperative were (94.5%±2.7%)(96.9%±2.4%) and (2.7°±1.4°) ,lost rate in followed—up were (4.3%±0.5%)(1.2%±0.3%)and(0.5°±0.2°).In the posterior surgeries :In postoperative ,heightsof the anterior and posterior edge of fractured vertebrae and the Cobb's angle were (47.7%±10.8%) (76.8%±13.5%) and (22.3°±5.7°) ,in Postoperative were (92.4%±3.4%) (95.8%±2.1%) and (2.8°±0.9°) ,lost rate in followed—up were (9.7%±1.2%) (3.6%±0.5 %) and (5.3°±2.1°) . There existed variance between the two groups in preoperative, Anterior group more serious degree of compression and kyphosis than posterior group. In postoperative,there have no variance between the two groups,both of which were satisfied with the reduction. There existed significant variance between the two groups in followed—up. Posterior group correction loss rate was significantly loss than the anterior group; In preoperative spinal canal space, anterior group was 46.2%±12.4% posterior group was 40.6%±15.5%, in postoperative were 3.0%±4.0% and 16.2%±11.9% .Anterior group spinal canal encroachment clearance rate was significantly superior than the posterior group; Posterior group surgery time was shorter than the anterior group and bleeding less than it; Anterior group fusion rate higher than posterior group. Conclusion : It is effective through surgical management of thoracolumbar bursting fractures by anterior or posterior approach. The choice of anterior or posterior surgery for thoracolumbar burst fractures depends on vertebral compression, canal encroachment, posterior column stability and concomitant displacement should be considered in the choice of appreciate surgical approach.