Management of late presented thoracolumbar spine fracture: Comparison of clinical and radiological outcome in anterior and posterior approach

Abstract

Abstract Background: Between 5% and 10% of polytrauma patients suffer spinal fractures or dislocations. The vast majority of these injuries affect the motion segments between T11 and L2 at the thoracolumbar junction. A few thoracolumbar fractures may be treated conservatively by rigid orthosis and prompt mobilisation, but a large number of such injuries are better managed surgically. A variety of surgical approaches viz. Anterior, posterior or circumferential/combined are used to decompress and stabilise injured thoracolumbar spine. The ideal method is still a matter of some debate, and in most cases, the operative plan is influenced by both clinical and radiological conditions. The purpose of this study was to compare the results of anterior versus posterior decompression and reconstruction of the spine in late presentation (>3 weeks). Materials and Methods: A prospective and randomised study was conducted from September 2012 to August 2014. Thirty patients with thoracolumbar spinal fractures (D11–L2) were taken for the study as per inclusion/exclusion criteria. The patients were operated 3 weeks after the injury due to late presentation. All patients underwent decompression and fixation of the spine using various methods either by anterior approach or posterior approach (15 patients in each group). All patients had Thoracolumbar Injury Classification and Severity Score 5 or more with age belonging to the age group of 15–65 years. On admission, American Spinal Injury Association Impairment Score (ASIA score) was evaluated and Frankel grade was assigned to each patient. Operative time, intraoperative blood loss, intraoperative and postoperative complications were noted. Neurology was assessed again at the time of discharge after surgery and at follow-up at month and then at 3-month intervals. Radiological evaluation is done based on a kyphotic angle before surgery and at follow-up visits. Clinical outcome variables analysis was done using an Unpaired t test and Graph Pad software. Significance was set at the P < 0.05 level. Results: Of 30 patients, 15 belonged to each group. Group A (operated with an anterior approach) and group B (operated with a posterior approach) were comparable in terms of patient demographics, type of fracture, and follow-up duration. No patient suffered from neurological deterioration post-surgery. ASIA score improvement in group A is 66 points and in group B is 59 points. Frankel grade improvement is up to 1.3 in group A and 1.2 in group B. Cosmetic results were better in a posterior group with the shorter incision. Conclusion: With this comparative study, we find that the anterior approach is better in overall outcome if operated after 3 weeks of injury.