Introduction: No consensus exists for the management of unstable thoracolumbar (TL) burst fractures. Surgical options include anterior, lateral, or posterior stabilization (or some combination of those options), depending on the fracture. The potential benefits of anterior reconstruction (eg, direct compression, better kyphotic deformity correction, and 3-column stability) come with increased operative time and associated morbidity. A posterior-only approach can offer stable correction without increased operative risks, but may increase the risk of limited kyphotic correction. Anterior stabilization may offer better decompression and neurological improvement compared to posterior treated patients. The goal of this study was to determine whether posterior-only stabilization is a viable treatment option for patients with traumatic TL fractures as opposed to anterior and combined approaches.
Methods: We performed a retrospective analysis of adult patients with TL burst fractures who underwent posterior-only surgical intervention from 2005 to 2015. Operations were performed at 2 levels above and below the fractured segment using pedicle screw-rod fixation constructs with autograft and allograft. All patients received TL bracing for at least 3 months. Patients lost to follow-up were excluded.
Results: Sixty-four consecutive patients with posterior-only stabilization were identified, with 18 lost to follow-up. Of the remaining 46 patients, 93% were male, and 7% were female, with a mean age of 36.8 years. Mean time until removal of the brace was 3.54 months. No patients required additional surgical intervention for spinal stabilization. Three patients experienced postoperative complications, all of which were related to infection.
Conclusions: Our data indicate posterior-only stabilization for traumatic TL burst fractures is a durable and effective option in select patients. The approach offers surgical intervention with a decreased peri-operative risk as well as morbidity and mortality, with a minimal increase in the risk of kyphotic deformity. Further prospective studies are necessary to validate these findings clinically.
Patient Care: Our data supports posterior-only fusion as an effective and durable approach for treatment of traumatic burst fractures, which offers a decreased peri-operative risk compared to alternative approaches.
Learning Objectives: 1. By the end of this session, participants should be able to discuss benefits and drawbacks of anterior spinal fusion and combined anterior and posterior spinal fusion for traumatic unstable thoracolumbar fractures.
2. Participants should be able to discuss benefits and drawbacks of posterioronly spinal fusion for traumatic unstable thoracolumbar fractures.
3. Identify settings in which posterioronly spinal fusion may be appropriate.