SELECTION CRITERIA AND OUTCOME OF OPERATIVE APPROACHES FOR THORACOLUMBAR BURST FRACTURES WITH AND WITHOUT NEUROLOGICAL DEFICIT

Criteria for choosing operative techniques for the treatment of thorac olumbar burst fractures remain disputed, particularly in neurologicall y intact patients. A retrospective study of 25 patients with thoracolu mbar burst fractures was performed to assess fracture characteristics, operative approaches, fixation, radiographic results, and neurologica l, functional, and pain outcomes. Anterior corpectomy, allograft strut , and plate fixation were performed in 14 patients with or without neu rological deficit when vertebral compression or canal encroachment was at least 40% or kyphosis was 15 degrees or more with a stable posteri or column. In nine cases, an anterior operation and a posterior segmen tal fixation were combined for similar deformity and three-column inst ability. Posterior transpedicular decompression fixation, and fusion w ere used primarily for two symptomatic patients with less than 30% enc roachment and at most 40% compression. Overall, 21 patients (84%) were walking and 18 (72%) were continent at follow-up evaluation (mean 16. 3 months) versus eight (32%) and 11 (44%) at presentation, respectivel y. Preoperatively, 17 patients experienced neurological deficit; 16 im proved and 12 increased one Frankel grade. No patient deteriorated. Pr ior employment or activity level was resumed by 19 patients (76%) and only four patients professed incapacity. Pain was eliminated after 18 procedures (72%), all anterior or combined approaches. Restoration of anatomical alignment (< 5 degrees) was achieved in 19 cases. No anteri or construct failed and only one patient treated posteriorly had posto perative kyphosis progression. Operative morbidity occurred in three c ases (12%). Satisfactory neurological and functional outcomes were ach ieved in a majority of patients with thoracolumbar burst fractures aft er correction of canal compromise, middle column compression, and atte ndant deformity. These results indicate that anterior decompression an d a weight-bearing strut graft are critical to clinical success in pat ients with significant vertebral destruction.