Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study.
OBJECTIVE
A prospective randomized study was conducted to determine whether there exist any differences in radiographic, clinical, or functional outcomes when individuals with stable burst fractures of the thoracolumbar junction without neurologic deficit are treated with either a posterior fusion with instrumentation or anterior reconstruction, fusion, and instrumentation. There exists relatively little literature evaluating the outcomes of individuals treated with anterior surgery, and no prospective randomized studies exist comparing the two treatment approaches.


METHODS
From May 1995 to March 2001, a consecutive series of subjects with acute isolated burst fractures of the thoracolumbar junction (T10-L2) without neurologic deficit were randomized to receive either an anterior fusion with instrumentation or a posterior fusion with instrumentation. Radiographs including computed tomography (CT) were obtained. Radiographs were repeated at 2, 4, 6, 12, and 24 months. The CT scan was also repeated at 24 months. Hospital stay, cost, operating time, blood loss, complications, and patient-related functional outcomes were measured.


RESULTS
Of 43 enrolled, 38 completed a minimum of 2-year follow-up (average: 43 months; range: 24-108 months). Eighteen received a posterior spine fusion and 20 an anterior approach. Hospital stay and operating time were similar. Blood loss was higher in the group treated anteriorly; however, the incidence of transfusion was the same. There were 17 "complications" including instrumentation removal for pain in 18 patients treated posteriorly, but only 3 minor complications in 3 patients treated anteriorly. Patient-related functional outcomes were similar for the two groups.


CONCLUSIONS
Although patient outcomes are similar, anterior fusion and instrumentation for thoracolumbar burst fractures may present fewer complications or additional surgeries.
Wood
K B
KB
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. kbwood@partners.org
Bohn
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Mehbod
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D000293:Adolescent; D000328:Adult; D001416:Back Pain / Q000209:etiology / Q000628:therapy; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000592:standards*; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D019106:Postoperative Hemorrhage; D011446:Prospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000191:economics / Q000295:instrumentation* / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome