SURGICAL APPROACHES FOR THE CORRECTION OF UNSTABLE THORACOLUMBAR BURST FRACTURES - A RETROSPECTIVE ANALYSIS OF TREATMENT OUTCOMES

The authors retrospectively studied 49 nonparaplegic patients who sust ained acute unstable thoracolumbar burst fractures. All patients under went surgical treatment and were followed for an average of 27 months. All but one patient achieved solid radiographic fusion. Three treatme nt groups were studied: the first group of 16 patients underwent anter ior decompression and fusion with instrumentation; the second group of 27 patients underwent posterior decompression and fusion; and the thi rd group of six patients had combined anterior-posterior surgery. Prio r to surgical intervention, these groups were compared and found to be similar in age, gender level of injury, percentage of canal compromis e, neurological function, and kyphosis. Patients treated with posterio r surgery had a statistically significant diminution in operative time and blood loss and number of units transfused. There were no signific ant intergroup differences when considering postoperative kyphotic cor rection, neurological function, pain assessment, or the ability to ret urn to work. Posterior surgery was found to be as effective as anterio r or anterior-posterior surgery when treating unstable thoracolumbar b urst fractures. Posterior surgery, however, takes the least time, caus es the least blood loss, and is the least expensive of the three proce dures.