Thoracolumbar burst fractures in patients with neurological deficit: Anterior approach versus posterior percutaneous fixation with laminotomy

Thoracolumbar burst fractures (TLBFs) are the most common spinal trauma; however, their appropriate management has not yet been determined. In this study, we aimed to compare the clinical and radiological results of percutaneous pedicle screw fixation (PPSF) following posterior decompression technique versus anterior corpectomy and fusion technique for the treatment of TLBFs.A total of 46 patients (2002-2015) with TLBFs were included in this study. The inclusion criteria were a single-level Magerl type A3 burst fracture of the thoracolumbar junctional spine (T12-L2). The patients were divided into two groups; Group A (22 patients) underwent anterior corpectomy and fusion, and Group B (24 patients) underwent PPSF after posterior decompression. Anterior corpectomy and fusion surgery were performed in 22 cases before April 2009, and PPSF following posterior decompression technique was used in 24 cases since then. For radiological assessment, the kyphosis angle was measured preoperatively, early postoperatively, and at the last follow-up using the Cobb angle. Mean correction of the Cobb angle after surgery, and loss of correction between the immediate postoperative and final Cobb angle were calculated accordingly. All neurological deficits were identified in the initial evaluation and graded using the American Spinal Injury Association(ASIA) grading system. Perioperative parameters including operation time, amount of blood loss, and mean hospital stay were also evaluated.The patients comprised 17 males and 5 females in Group A and 13 males and 11 females in Group B. In terms of the involved levels, there were three cases of T12, twelve L1, and seven L2 in Group A and one case of T12, thirteen L1, and ten L2 in Group B. The mean follow-up duration was 44.9 months in Group A and 14.7 months in Group B. The kyphotic angle was significantly corrected after surgery by 6.4° in Group A (p = 0.001) and 9.2° in Group B (p < 0.001). Among patients with neurological deficit, 11 of 15 in Group A and 20 of 23 in Group B demonstrated improvement by at least one ASIA grade at the final observation. However, there was no significant difference in neurological improvement between the two groups (p = 0.13). Mean operation time was significantly shorter (p < 0.001) and mean blood loss was significantly less (p < 0.001) in Group B than in Group A. Mean hospital stay was also significantly shorter in Group B (p < 0.001).Spinal canal decompression through small laminectomy followed by PPSF in the treatment of TLBFs with neurological deficits offers excellent clinical and radiological improvement as well as biomechanical stability. Furthermore, this can be a safe and effective surgical option with the advantage of less invasiveness in the treatment of TLBFs.