Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review

Background Data: The management of unstable traumatic thoracolumbar fractures has shifted from more conservative treatment to more operative treatment modalities. Different surgical options have been reported in the literature. Purpose: To review two surgical techniques, anterolateral and posterior...

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Autores principales:	Mohamed Mostafa Aziz, Ahmed Kotb, Hesham Anwar, Mohamed Fawzy Kattab
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2019
Materias:	Anterolateral approach transpedicular angular deformity thoracolumbar fractures spinal canal diameter Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/727bc86d22c14442bf612dc85492de2b
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spelling	oai:doaj.org-article:727bc86d22c14442bf612dc85492de2b2021-12-02T06:53:19Z Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review10.21608/ESJ.2019.7091.10872314-89502314-8969https://doaj.org/article/727bc86d22c14442bf612dc85492de2b2019-04-01T00:00:00Zhttps://esj.journals.ekb.eg/article_43538.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: The management of unstable traumatic thoracolumbar fractures has shifted from more conservative treatment to more operative treatment modalities. Different surgical options have been reported in the literature. Purpose: To review two surgical techniques, anterolateral and posterior approaches, in management of thoracolumbar fractures and present a brief literature review. Study Design: A retrospective case series with review of the literature. Patients and Methods: Thirty patients were managed in the period from October 2012 to November 2016 for thoracolumbar burst fractures. Two patients’ groups were identified: Group I underwent anterolateral fixation and included 15 patients, whereas Group II underwent posterior fixation and included 15 patients. Follow-up was done at 3 months, 6 months, and one year postoperative using VAS for pain assessment and ASIA scale for neurological status evaluation. Radiological outcome involved the vertebral height restoration, spinal canal compromise, and kyphus deformity correction. Operative time, operative blood loss, and perioperative complications were all reported for both groups. Results: The most common spinal level affected in our study was L1 vertebra in 10 patients. Operative time and blood loss were found to be significantly less in the posterior approach. A significant improvement of VAS has been reported in both study groups with more improvement in the posterior group compared with the anterolateral one. 93.3% of anterior group patients within the showed either improved or fixed neurological status according to ASIA scale where, in posterior group, all patients showed either improved or fixed neurological status. The mean canal compromise percentage decreased in Group I from 69.3% preoperatively to 15.62% postoperative, whereas in Group II it decreased from 66.2% preoperative to 18.8%. Kyphotic angle has been corrected in posterior group from 13.42° preoperative to 11° at 6 months and 12.5° at one year, whereas in anterolateral group it has been corrected from 19.42° to 17.57° and 20.9°, respectively, with a statistically significant difference between both groups (P<0.01). Conclusion: Our data suggest that both anterior and posterior approach showed no difference in neurological outcome in patients with thoracolumbar fractures. However, anterior approach was superior to the posterior one in spinal canal compromise clearance and kyphotic angle correction. (2019ESJ174) Mohamed Mostafa AzizAhmed KotbHesham AnwarMohamed Fawzy KattabEgyptian Spine AssociationarticleAnterolateral approachtranspedicularangular deformitythoracolumbar fracturesspinal canal diameterNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 30, Iss 1, Pp 12-22 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Anterolateral approach transpedicular angular deformity thoracolumbar fractures spinal canal diameter Neurology. Diseases of the nervous system RC346-429
spellingShingle	Anterolateral approach transpedicular angular deformity thoracolumbar fractures spinal canal diameter Neurology. Diseases of the nervous system RC346-429 Mohamed Mostafa Aziz Ahmed Kotb Hesham Anwar Mohamed Fawzy Kattab Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review
description	Background Data: The management of unstable traumatic thoracolumbar fractures has shifted from more conservative treatment to more operative treatment modalities. Different surgical options have been reported in the literature. Purpose: To review two surgical techniques, anterolateral and posterior approaches, in management of thoracolumbar fractures and present a brief literature review. Study Design: A retrospective case series with review of the literature. Patients and Methods: Thirty patients were managed in the period from October 2012 to November 2016 for thoracolumbar burst fractures. Two patients’ groups were identified: Group I underwent anterolateral fixation and included 15 patients, whereas Group II underwent posterior fixation and included 15 patients. Follow-up was done at 3 months, 6 months, and one year postoperative using VAS for pain assessment and ASIA scale for neurological status evaluation. Radiological outcome involved the vertebral height restoration, spinal canal compromise, and kyphus deformity correction. Operative time, operative blood loss, and perioperative complications were all reported for both groups. Results: The most common spinal level affected in our study was L1 vertebra in 10 patients. Operative time and blood loss were found to be significantly less in the posterior approach. A significant improvement of VAS has been reported in both study groups with more improvement in the posterior group compared with the anterolateral one. 93.3% of anterior group patients within the showed either improved or fixed neurological status according to ASIA scale where, in posterior group, all patients showed either improved or fixed neurological status. The mean canal compromise percentage decreased in Group I from 69.3% preoperatively to 15.62% postoperative, whereas in Group II it decreased from 66.2% preoperative to 18.8%. Kyphotic angle has been corrected in posterior group from 13.42° preoperative to 11° at 6 months and 12.5° at one year, whereas in anterolateral group it has been corrected from 19.42° to 17.57° and 20.9°, respectively, with a statistically significant difference between both groups (P<0.01). Conclusion: Our data suggest that both anterior and posterior approach showed no difference in neurological outcome in patients with thoracolumbar fractures. However, anterior approach was superior to the posterior one in spinal canal compromise clearance and kyphotic angle correction. (2019ESJ174)
format	article
author	Mohamed Mostafa Aziz Ahmed Kotb Hesham Anwar Mohamed Fawzy Kattab
author_facet	Mohamed Mostafa Aziz Ahmed Kotb Hesham Anwar Mohamed Fawzy Kattab
author_sort	Mohamed Mostafa Aziz
title	Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review
title_short	Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review
title_full	Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review
title_fullStr	Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review
title_full_unstemmed	Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review
title_sort	thoracolumbar fractures, posterior versus anterior management: a case series and literature review
publisher	Egyptian Spine Association
publishDate	2019
url	https://doaj.org/article/727bc86d22c14442bf612dc85492de2b
work_keys_str_mv	AT mohamedmostafaaziz thoracolumbarfracturesposteriorversusanteriormanagementacaseseriesandliteraturereview AT ahmedkotb thoracolumbarfracturesposteriorversusanteriormanagementacaseseriesandliteraturereview AT heshamanwar thoracolumbarfracturesposteriorversusanteriormanagementacaseseriesandliteraturereview AT mohamedfawzykattab thoracolumbarfracturesposteriorversusanteriormanagementacaseseriesandliteraturereview
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Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review

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