A prospective study of anterior versus posterior approach for traumatic thoracolumbar fractures: A systemic review

The objective of this study was to compare the results of reconstruction of the spine with anterior corpectomy and fusion versus pedicle screw fixation after the laminectomy technique in the treatment of thoracolumbar burst fractures (TLBFs).

TLBFs account for the most common spinal trauma. There exists no single consensus on the best approach to surgical fixation of thoracolumbar fractures. However, its appropriate management remains a point of bias. Traditionally, it has been considered that the anterior approach has more morbidity in terms of more blood loss and longer operation time and complications. However, from the standpoint of the neurological and functional outcome, there exists no statistical difference between these two approaches. Yet, explaining from a biomechanical perspective, there exist some studies which provide the anterior approach with few, if, not many, advantages over the posterior approach. This has led to a renewed interest in anterior approaches to thoracolumbar traumatic burst fractures. We explore this finding with our case series on thoracolumbar fracture treatment with the anterior approach in terms of intra-op events: duration and blood loss, postoperative outcome - neurological improvement status, and long-term follow-up and functional outcome.

A total of 32 patients (from year January 2015 to December 2017) with TLBFs were divided into two groups randomly. Group A was treated with an anterior approach and Group B was treated with a posterior approach with pedicle screw fixation after laminectomy and decompression. Patients with a minimum follow-up period of 24 months were prospectively evaluated. We reviewed their neurological and clinical outcomes in their follow-up period. Then, we performed a literature review via PubMed for publications based on the comparison between anterior and posterior approaches and we included 29 articles based on our criteria. We focused on three main determinants-acute perioperative events (which include blood loss, and long duration of surgery,) neurological deterioration of function, and lastly, functional outcome-Frankel score for neurological improvement and any presence of adverse construct defects in hardware.

All patients in this study who underwent anterior corpectomy and fusion achieved solid fusion, with significant neurological improvement. Results showed significant differences between the American Spinal Injury Association motor score, and the Frankel scale (P < 0.05) between the two Groups A and B. At the final follow-up, both groups showed improvement in their neurological function (Group A > Group B). In Group B, the operative time was shorter (P < 0.05), and intraoperative blood loss (P < 0.05) was less.