Thoracolumbar burst fractures treated with combined anterior and posterior surgery

Between 1985 and 1992, 84 burst fractures were surgically managed with anterior decompression, autologous iliac crest strut graft, and posterior instrumentation and fusion. Fifteen were lost to follow-up, leaving 69 patients for detailed review. Of the 22 patients with complete or partial neurologic injury, 12 patients either totally or partially recovered function following surgery. Of these 12 patients, 6 improved 1 Frankel grade; 5 improved 2 Frankel grades, and 1 improved 3 Frankel grades. Follow-up was 12 to 91 months (average 41 months). For all of the fractures in this series, the mean operative correction in sagittal kyphosis was 14 degrees, but this decreased to 7 degrees at final review. No patient had significant scoliosis, and 66 patients achieved solid arthrodesis with 3 pseudoarthroses (4%). Mean operative time for 2-in-1 procedures was 5 hours 42 minutes, with an estimated blood loss of 1,455 mL. Of 62 patients available for follow-up telephone interview, 42 (68%) had minimal or no pain; 11, mild pain; 8, moderate pain; and 1, severe pain. Function in daily activities was assessed as normal or minimally impaired in 43 of 51 patients (84%) with normal neurologic function by physical examination. We conclude that anterior decompression, strut autografting, and posterior instrumented autogenous fusion, either as a combined or staged procedure, is a safe surgical option for thoracolumbar burst fractures.