DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20181672

Anterior reconstruction of spine by posterior approach in cases of unstable thoracolumbar burst fractures

Anurag Tiwari, Ankit Thora, Mukul Mohindra, Amit Sharma, Sumit Sural, Anil Dhal

Abstract


Background: The purpose of this study is to evaluate neurological, functional and radiological outcome of the anterior reconstruction of spine by posterior approach in cases of unstable thoracolumbar burst fractures.

Methods: Ten patients with acute unstable burst fractures at thoracolumbar junction (T-11 to L-3) with partial or complete neurological deficit in the age group of 18-50 years with McCormack’s score six or more and thoracolumbar injury severity score (TLISS) five or more were included. Neurological status, Japanese Orthopaedic association score (JOA score), visual analogue scale (VAS), angle of kyphotic deformity, McCormack’s score and TLISS score were evaluated.

Results: The mean duration of surgery was 282 minutes. The mean blood loss was 1885 ml. Five patients with neurologic deficit recovered an average of 1.40 ASIA grades at last 24 months’ follow-up. The JOA score improved from -6 preoperatively to 11 at 24 months follow up. The mean kyphotic angle was 19 degrees preoperative improved to -0.6o postoperatively. Visual analogue score improved from 6.1 to 1.7.

Conclusions: The familiar posterior approach is a safe and reliable surgical approach for reconstruction of all the columns of spine. It has the advantage of doing anterior decompression and reconstruction with posterior instrumentation in single stage, reducing the operative time and blood loss. It reduces the morbidity of anterior approach (isolated or two staged) in the hands of an average orthopaedic surgeon.


Keywords


anterior reconstruction; posterior approach; unstable; burst fracture; titanium cage.

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