| Objective:To compare anterior approach to posterior approach in the clinical outcome of treatment for thoracolumbar unstable burst fracture,and to evaluate the postoperative functional recovery and interbody fusion .Methods:the clinical and radiographic results of 300 patients with thoracolumbar vertebral fracture were collected from January 2005 to October 2010, 57 cases accorded with the inclusive criteria were analyzed restrospectively in the follow-up result.32 were males and 25 were females ,the mean patients' age was 35 yeas old (20-57yeas old),and the follow-up averaged 19 months (range :15-24 month); 36 patients had injury due motor vehicle accident (MVA) ,18 had injury due to fall from height and 3 had injury due to fall of heavy objective.There were 6,22,23 and 8 patients who had fractures at T11,T12,L1 and L2 level,respectively.Neurologic injury was graded by ASIA,Anterior group :there were 1,1,4,4 and 12 patients with ASIA grade A ,B,C,D and E,respectively.Posterior group:there were 0,1,5,4 and 25 patients with ASIA grade A ,B,C,D and E,respectively.McAfee's system was used to classify the fractures,and all patients were unstable burst fractures .X-ray,CT,MRI of spine were routinely carried out preoperatively.All patients were operated surgically in admission during 24-96 hours. 35 cases are operated by posterior decompression,discectomy,TLIF(Transforaminal Lumbar Interbody Fusion) or with cage and pedicle screw fixation (anterior group );22 cases are operated by anterior fixation , vertebraectomy at fractured vertebra and bone graft(posterior group ) .Operation time and intraoperative bleeding were evaluated between two surgical methods ;X-ray (3 months ,6 months,9 months,12months,final follow-up) was used for evaluation of the correction of kyphotic angle,loss of kyphosis and location of internal fixation screw at final follow-up; CT scan of the involved vertebra(2 weeks,12 months) was used for evaluation of the injured vertebral spinal canal encroachment.ASIA grade system was used for assessment of neurological deficit on admission and at the subsequent follow-up.The degree of instability scored by the Oswestry disability index(ODI) was used for assessment of clinical outcomes. Spinal fusion was evaluated by SUK system. statistical analysis methods should be reasonably chosen.Results:thracolumbar burst fracture treated by anterior or posterior approach,the mean operative duration and bleeding were 235±55 min and 920±380 ml in anterior and posterior group respectively, 190±53 min and 580±240 ml in the posterior group,two groups have significant difference(P<0.05) .20 cases (10 in anterior group and 10 in posterior group)accompanied by neurological deficit improve 1-2 ASIA grade at follow-up, which showed no significant difference(P>0.05). the mean correction of kyphotic angle were 20.20±2.51°and 21.35±1.85°(P>0.05);loss of kyphosis at follow-up were 2.8±1.2°and 5.8±1.9°(P<0.05)in anterior and posterior group respectively. 57 patients we assessed current subjective status and symptoms through a questionnaire using the Oswestry Disability Index score.The assessments were completed by asking questions over a telephone in 12 month after operation.ODI was 26.7±6.21 in anterior group and 28.3±5.26 in posterior group (P>0.05).According to SUK criterion , All the patients achieved solid bony union at final follow-up.the average bone fusion time were 15 months(range5-22).in 6 months,anterior group achieve more high bony union than the posterior group (P<0.05).in 12 months,19 of 22 patients got a solid bone fusion in anterior group , and frequency of fusion was 86.4%;30 of 35 patients achieve a solid bone fusion in posterior group with frequency of fusion 86.4%.There was no significant different between two groups(P>0.05).Conclusion:1.Thoracolumbar unstable burst fracture were treated by anterior or posterior surgery approach ,which is characterized by perfect correcting of kyphosis angle,good recovery of neurological functions,high frequency of fusion,and better clinical outcome.2.More thorough decompression may be achieved due to discectomy of harm vertebrae by anterior approach. small loss of kyphosis correction is observed in this surgery .However it has many disadvantages,such as more operation time,more blood loss,iliac-taking zone pain ,more postoperative complications .3.There is short operation time and less bleeding by posterior approach.posterior approach may avoid the interference of the abdominal organs and chest organs ,be easier to manage patients for fewer complications.large loss of kyphosis correction is observed ,but clinical efficacy was not affected... |
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