Anterior Versus Posterior Instrumentation for Thoracolumbar Fractures

Background: Most authors agree that surgical treatment is required for symptomatic, unstable burst thoracolumbar fractures. Aim: to assess and evaluate feasibility, efficacy, advantages and disadvantages of anterior instrumented fusion of thoracolumbar fractures compared to posterior as regard neurological status, radiological union and loss of correction. Methods: This study was composed of 30 patients with thoracolumbar fractures with or without neurological impairment. These patients were treated surgically at; Nasr city hospital for health insurance and Helmia military hospital, during the period form 2016 to 2019. 15 patients were treated by anterior approach, direct decompression, rib bone graft and anterior fixation (group A). 15 patients were treated by posterior approach, indirect decompression and stabilization of their fractures by transpedicular fixation with or without postrolateral bone graft (group B). Results: mean gain in reduction of 15,1° and a mean loss at 1year follow-up of 2 °for Group A and mean gain in reduction of 7,1° and a mean loss at 1year follow-up of 6,7 ° for Group B During the follow-up period only one patient (case 8), showed loss of reduction another operation was done later where posterior corpectomy for L2 and posterior instrumnted fusion was added using pedicular screws and pyramish. One patient (case 6) develop postoperative atelectasis, in the right (contralateral) lung, which was downside, resulting from surgical positioning, the patient was treated by semi sitting position, chest exercises, broad spectrum antibiotics and early mobilization as soon as general condition improved. Three patients (case 7), (case 17), (case 20), developed urinary tract infection.They were treated by frequent change of the uretheral catheter, antibiotics and urinary antiseptics. Conclusion: The results of this review showed that in the surgical management of thoracolumbar fractures, the anterior approach was significantly superior to the posterior approach in terms of gain of correction with lower incidence of loss of correction on long term follow up as well as recovery of neurological function and return to work. The anterior approach was disadvantageous in terms of operative time, blood loss and cost however Septic complications and postoperative neurologic aggravation are less frequent than in posterior surgery