Modified one-stage posterior/anterior combined surgery with posterior pedicle instrumentation and anterior monosegmental reconstruction for unstable Denis type B thoracolumbar burst fracture

• Published in: European spine journal Vol. 26; no. 5; pp. 1499 - 1505
• Main Authors: Lai, Oujie, Hu, Yong, Yuan, Zhenshan, Sun, Xiaoyang, Dong, Weixin, Zhang, Jiao, Zhu, Binke
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2017; Springer Nature B.V
• Subjects: Adult; Follow-Up Studies; Humans; Lumbar Vertebrae - injuries; Lumbar Vertebrae - surgery; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Pedicle Screws; Postoperative Complications; Spinal Fractures - surgery; Spinal Fusion - adverse effects; Spinal Fusion - statistics & numerical data; Surgical Orthopedics; Thoracic Vertebrae - injuries; Thoracic Vertebrae - surgery; Posterior/anterior combined surgery; Anterior monosegmental reconstruction; Thoracolumbar burst fracture; Posterior instrumentation
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-016-4800-1

Purpose This study aimed to evaluate the clinical and radiological results in patients with unstable Denis type B thoracolumbar burst fractures treated by modified one-stage posterior/anterior combined surgery. Methods Thirty-one patients with unstable Denis type B thoracolumbar burst fractures were enrolled in this study. The patients underwent one-stage posterior/anterior combined surgery with posterior instrumentation using pedicle screws and anterior monosegmental reconstruction utilizing titanium mesh cages. The mean follow-up period was 38.3 months. Clinical outcomes, radiological parameters, and treatment-related complications were assessed. Results The mean age of the patients was 36.4 years. The mean operative time and blood loss were 230 min and 645 ml, respectively. The VAS pain score was significantly improved after surgery, and the improvement was maintained until the final follow-up. In 23 patients with neurologic dysfunction, 20 (87 %) patients had improvement after surgery. By the final follow-up, 27 patients had returned to work; 18 of the 27 patients returned to a similar job. The mean sagittal kyphosis was corrected from 21.2° preoperatively to 2.5° postoperatively, which increased slightly to 4.3° at the final follow-up. Minimal subsidence and tilt of the titanium mesh cage were observed during the follow-up period. Solid bony fusion was achieved in all patients. One patient developed a posterior surgical site infection, which was resolved by antibiotic treatment and surgical debridement. Conclusion Modified one-stage posterior/anterior combined surgery for Denis type B unstable thoracolumbar burst fractures can produce good clinical and radiological outcomes.