Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures

Abstract

Object The authors undertook a retrospective cohort study of patients with T11–L2 thoracolumbar burst fractures who underwent decompression and the placement of instrumentation via the anterolateral or posterior approach. Methods There were 63 thoracolumbar burst fractures in 45 male and 18 female patients. The instrumentation was placed posteriorly in 25 patients and anterolaterally in 38. The mean follow-up duration after discharge from the hospital was 1.8 years (range 6 months–8 years). The mean preoperative Frankel scores in the anterolateral and posterior groups were 3.7 ± 1.1 and 3.5 ± 1.4, respectively (p = 0.4155). Preoperative angular deformity in the anterolateral and posterior groups measured 11.9 ± 9.7 and 4.1 ± 7.1°, respectively (p = 0.0007). Postoperatively, angular deformity had been corrected to 2.0 ± 7.9 and 3.4 ± 7.5° in both groups, respectively (p = 0.565). The follow-up Frankel scores had improved to 4.2 ± 0.8 and 4.0 ± 1.4 (p = 0.461). At the latest follow-up examination, angular deformity had progressed to 4.5 ± 9.3° in the anterolateral group and to 9.8 ± 9.4° in the posterior group (p = 0.024). Although surgeons’ fees were significantly (p = 0.0024) higher for patients who underwent anterolateral procedures ($27,940 ± 4390) than for those who underwent posterior surgery ($18,270 ± 6980), there was no intergroup difference in total cost of hospitalization. Conclusions Rigid guidelines for the selection of anterior or posterior approaches are lacking. Evaluation of the authors’ results and those of others shows that angular deformity is more successfully corrected and maintained when the anterior approach is used.