Surgical Decision-Making in Thoracolumbar Fractures: A Systematic Review of Anterior and Posterior Approach

Fractures in the thoracolumbar region of the vertebral column are very common and often require surgical intervention. Surgery is typically aimed at restoring or maintaining neurological function and correction of the vertebral column.

There are two commonly used approaches for surgery, the anterior and the posterior approach. Uncertainties remain regarding the best surgical approach for the treatment of traumatic thoracolumbar fractures. The results of studies comparing the anterior and posterior surgical approaches for treating thoraco-lumbar fractures have been compiled in this review. Numerous metrics, including neurological results, Cobb angle recovery, and post-operative complications, have been used. It was observed that both approaches yielded a similar result when considering the improvement in Frankel grades and recovery of the Cobb angle.

We further report that patients undergoing decompression using the anterior approach incurred higher blood loss, longer hospital stays, and higher operating costs; these findings support the posterior approach as being safer and more practical.