Simultaneous combined anterior and posterior surgery for severe thoracolumbar fracture dislocations

To analyze the clinical results of simultaneously combined anterior and posterior surgery for severe thoracolumbar fracture dislocations, and to clarify the surgical indications for these high-energy injuries.

Thirty-four patients with severe thoracolumbar fracture dislocations were managed with simultaneously combined anterior and posterior surgery. The injured segments included the following: T11 (2 patients), T12 (5), L1 (1), L2 (8), L3 (5), L4 (2) and L4 and L5 (1). When classified according to the Magerl Classification, the breakdown was as follows: 12 A3 injuries, 2 B1, 2 B2, 12 C1 injuries, 4 C2, and 2 C3. Clinical data, including operative procedures, neurological changes, postoperative CT scans and sequential radiographs, was collected and analyzed. Thirty-two patients were followed up for an average of 13 months (range, 6-60).

Operative time ranged from 180 to 320 min with a mean of 230 min. Intraoperative blood loss ranged from 900 to 2400 ml with a mean of 1200 ml. According to the classification of the American Spinal Injury Association (ASIA), neurological status improved at least 1 grade in all of the 24 patients who had an incomplete paralysis preoperatively. Satisfactory decompressions, reductions and reconstructions were obtained and well maintained in all patients at all intervals of follow-up.

For severe thoracolumbar fracture dislocations that cannot be effectively treated with either an anterior or posterior approach alone, simultaneously combined anterior and posterior surgery is a reliable method that can achieve a sufficient decompression, reduction and reconstruction.