Background: Lumbar burst fractures are common spinal injuries that cause severe
instability with kyphotic deformities and neurological complications requiring surgical
decompression and reconstruction with spinal instrumentation for unstable burst
fracture, but there is controversy about the optimal surgical approach anterior,posterior or combined
approach. Objectives: To assess the efficacy &safety of anterolateral approach
in decompression and reconstruction with spinal instrumentation for lumbar
burst fractures. Subjects &Methods:A
retrospective study including 16 patients, 10 males and 6 females with lumbar burst fractures
and anterior compression treated operatively by anterolateral approach for
corpectomy and single level fusion by using expandable cage or mesh cage loaded
with bone graft and plat with screws. The clinical and radiological follow up
after discharge from the hospital ranged from 12 to 24 months. Results:
All patients improved regarding the Frankel score more than one grade after
surgery, except 2 cases of grade A didn’t improve.Mean preoperative visual analogue scale was 7.4
improving to 0.9 postoperatively.The mean Local kyphosis improved from 8.8° before surgery to -1°
References
[1]
Vaccaro, A.R., Lim, M.R., Hurlbert, R.J., et al. (2006) Surgical Decision Making for Unstable Thoracolumbar Spine Injuries: Results of a Consensus Panel Review by the Spine Trauma Study Group. Journal of Spinal Disorders & Techniques, 19, 1-10.
https://doi.org/10.1097/01.bsd.0000180080.59559.45
[2]
Langrana, N.A., Harten, R.D., Lin, D.C., Reiter, M.F. and Lee, C.K. (2002) Acute Thoracolumbar Burst Fractures: A New View of Loading Mechanisms. Spine, 27, 498-508. https://doi.org/10.1097/00007632-200203010-00010
[3]
Thongtrangan, I., Le, H.N., Park, J. and Kim, D.H. (2006) Thoracic and Thoracolumar Fractures. In: Kim, D.H., Henn, J.S., Vaccaro, A.R. and Dickman, C.A., Eds., Surgical Anatomy & Techniques to the Spine, 9th Edition, Sunders Elsevier, Philadelphia, 352-363.
[4]
Lu, D.C., Lau, D., Lee, J.G. and Chou, D. (2010) The Transpedicular Approach Compared with the Anterior Approach: An Analysis of 80 Thoracolumbar Corpectomies: Clinical Article. Journal of Neurosurgery: Spine, 12, 583-591.
https://doi.org/10.3171/2010.1.SPINE09292
[5]
McCormack, T., Karaikovic, E. and Gaines, R.W. (1994) The Load Sharing Classification of Spine Fractures. Spine, 19, 1741-1744.
https://doi.org/10.1097/00007632-199408000-00014
[6]
Sasso, R.C., Best, N.M., Reilly, T.M. and McGuire, R.A.Jr. (2005) Anterior-Only Stabilization of Three-Column Thoracolumbar Injuries. Journal of Spinal Disorders & Techniques, 18, S7-14. https://doi.org/10.1097/01.bsd.0000137157.82806.68
[7]
McLain, R.F. (2004) Functional Outcomes after Surgery for Spinal Fractures: Return to Work and Activity. Spine, 29, 470-477.
https://doi.org/10.1097/01.BRS.0000092373.57039.FC
[8]
Danisa, O.A., Shaffrey, C.I., Jane, J.A., Whitehill, R., Wang, G.W., Szabo, T.A., et al. (1995) Surgical Approaches for the Correction of Unstable Thoracolumbar Burst Fractures: A Retrospective Analysis of Treatment Outcomes. Journal of Neurosurgery, 83, 977-983. https://doi.org/10.3171/jns.1995.83.6.0977
[9]
Crutcher, J.P.Jr., Anderson, P.A., King, H.A. and Montesano, P.X. (1991) Indirect Spinal Canal Decompression in Patients with Thoracolumbar Burst Fractures Treated by Posterior Distraction Rods. Journal of Spinal Disorders, 4, 39-48.
[10]
Korovessis, P., Baikousis, A., Zacharatos, S., Petsinis, G., Koureas, G. and Iliopoulos, P. (2006) Combined Anterior plus Posterior Stabilization versus Posterior Short-Segment Instrumentation and Fusion for Mid-Lumbar (L2-L4) Burst Fractures. Spine, 31, 859-868. https://doi.org/10.1097/01.brs.0000209251.65417.16
[11]
Payer, M. (2006) Unstable Burst Fractures of the Thoracolumbar Junction: Treatment by Posterior Bisegmental Correction/Fixation and Staged Anterior Corpectomy and Titanium Cage Implantation. Acta Neurochirurgica (Wien), 148, 299-306.
https://doi.org/10.1007/s00701-005-0681-5
[12]
Miyakoshi, N., Shimada, Y., Abe, E. and Suzuki, T. (2010) Effects and Complication Measures of the Instrumentation Surgery for Spinal Deformity in the Elderly. Orthopaedic Surgery and Traumatology, 53, 1043-1051.
[13]
Baron, E.M. and Albert, T.J. (2006) Medical Complications of Surgical Treatment of Adult Spinal Deformity and How to Avoid Them. Spine, 31, S106-S118.
https://doi.org/10.1097/01.brs.0000232713.69342.df
[14]
Hitchon, P.W., Tomer, J., Eichholz, K.M. and Beeler, S.M. (2006) Comparison of Anterolateral and Posterior Approaches in the Management of Thoracolumbar Burst Fractures. Journal of Neurosurgery: Spine, 5, 117-125.
https://doi.org/10.3171/spi.2006.5.2.117
[15]
Verlaan, J.J., Diekerhof, C.H., Buskens, E., van der Tweel, I., Verbout, A.J., Dhert, W.J., et al. (2004) Surgical Treatment of Traumatic Fractures of the Thoracic and Lumbar Spine: A Systematic Review of the Literature on Techniques, Complications, and Outcome. Spine, 29, 803-814.
https://doi.org/10.1097/01.BRS.0000116990.31984.A9
[16]
Kaneda, K., Taneichi, H., Abumi, K., Hashimoto, T., Satoh, S. and Fujiya, M. (1997) Anterior Decompression and Stabilization with the Kaneda Device for Thoracolumbar Burst Fractures Associated with Neurological Deficits. The Journal of Bone and Joint Surgery, American Volume, 79, 69-83.
https://doi.org/10.2106/00004623-199701000-00008
[17]
McLain, R.F., Burkus, J.K. and Benson, D.R. (2001) Segmental Instrumentation for Thoracic and Thoracolumbar Fractures: Prospective Analysis of Construct Survival and 5 Year Follow-Up. The Spine Journal, 1, 310-323.
https://doi.org/10.1016/S1529-9430(01)00101-2
[18]
Ghanayem, A.J. and Zdeblick, T.A. (1997) Anterior Instrumentation in the Management of Thoracolumbar Burst Fractures. Clinical Orthopaedics, 335, 89-100.
[19]
McAfee, P.C. (1994) Complications of Anterior Approaches to the Thoracolumbar Spine. Emphasis on Kaneda Instrumentation. Clinical Orthopaedics and Related Research, 306, 110-111.
[20]
McAfee, P.C., Bohlman, H.H. and Yuan, H.A. (1985) Anterior Decompression of Traumatic Thoracolumbar Fractures with Incomplete Neurological Deficit using a Retroperitoneal Approach. The Journal of Bone and Joint Surgery. American Volume, 67, 89-104. https://doi.org/10.2106/00004623-198567010-00012
[21]
Suzuki, T. and Abe, E. (2009) Spinal Instrumentation for Thoraco-Lumbar Injuries: Causes and Prevention of Their Revision Surgery. Spine, 22, 851-858.
