Posterior/anterior combined surgery for thoracolumbar burst fractures-posterior instrumentation with pedicle screws and laminar hooks, anterior decompression and strut grafting

Study design: A prospective clinical study. Objective: The purpose of this study was to evaluate prospectively a large group of patients with thoracolumbar burst fractures who were treated with a posterior/anterior combined procedure and to report on the surgical outcomes, complications and radiographic results. Methods: A total of 100 consecutive patients were surgically managed with posterior instrumentation, anterior decompression and anterior strut grafting. There were 71 males and 29 females; the mean age was 36 years. Patients with osteoporotic delayed vertebral body collapse were excluded. The mean follow-up period was 30 months. Surgical outcomes such as operative time, blood loss and sagittal alignment were investigated. A neurological assessment was performed by a rating system based on the American Spine Injury Association impairment scale. An interbody fusion was judged using plain X-ray and computed tomographic scans. Results: The mean operative time was 256 min and the mean operative bleeding was 985 ml. Most of the patients were ambulatory within 3 days after surgery. Of the 76 patients with neurological injury, 54 (71.1%) recovered function following surgery. The mean local kyphosis angle was 12.2 degrees kyphotic preoperatively and 0.8 degrees lordotic at the final observation. The mean correction angle was 15.7 degrees and correction loss was 2.6 degrees. No instrumentation failure was observed and the postoperative fusion rate was 99%. Conclusions: Posterior/anterior combined surgery with posterior pedicle screws and hooks fixation, and reconstruction by simultaneous strut grafting and anterior decompression, achieved short segment fixation and can be a useful option for surgically treating thoracolumbar burst fractures. Spinal Cord (2011) 49, 573-579; doi: 10.1038/sc.2010.159; published online 16 November 2010