A Comparative Outcome Analysis of Two Posterior Only Approach for Thoracolumbar Fracture
23 July 2019 (eFirst)
Objectives Most common surgical intervention in thoracolumbar fracture is pedicle screw fixation with posterior decompression through traditional posterior approach. Nowadays, we are doing combined anteroposterior decompression with anteroposterior fixation through posterior only approach. So, we attempt to compare these two approaches in terms of surgical and functional outcome.
Method This is a retrospective study. We included 47 patients of traumatic thoracolumbar fracture between September 2016 and January 2018. Fourteen patients were treated by three-column fixation through posterior only approach and 33 patients were treated with traditional posterior approach. In three-column fixation, transpedicular corpectomy with dynamic mesh cage placement with B/L pedicle screw fixation with 360 canal decompression was done, whereas in traditional posterior approach, only posterior decompression with B/L pedicle screw fixation was done. Parameters for comparison include patients’ parameters, fracture types, operative duration, average blood loss, kyphotic correction, and neurological and functional improvement after 1 week and 3 months postoperatively.
Result The average operative time (150 ± 13.01 minutes) and blood loss (263 ± 40.84 mL) in combined decompression and fixation through posterior only approach were higher than average operative time (120.3 ± 25.43 minutes) and average blood loss (108 ± 27.32 mL) in traditional posterior approach. In traditional surgeries, there was an observed correction of 11.7° ± 3.6° in kyphosis, while in combined surgeries the observed correction in kyphosis was 15.3° ± 4.3°. There is no statistically significant neurological and functional outcome than traditional posterior approach.
Conclusion Combined anteroposterior decompression and stabilization through posterior only approach is convenient for complete decompression of cord, stabilization, and restoration of vertebral height, and there is statistically significant kyphotic correction, pain relief (visual analogue scale), but there is no statistically significant neurological and functional outcome than traditional posterior approach. Most neurosurgeons are familiar to posterior approach; hence, they should be used in unstable thoracolumbar fracture whenever needed, while avoiding various dreaded complication of combined approach.
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