Abstract
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.
Keywords
traumatic thoracolumbar fracture - spinal injuries - three-column fixation - transpedicular
corpectomy - posterior only approach
