title: Combined posterior and delayed staged mini-open anterior short-segment fusion for thoracolumbar burst fractures.
abstract: METHODS
  A prospective study.
  
  
  OBJECTIVE
  To assess the outcome of patients with a single thoracolumbar burst fracture treated with circumferential short-segment fusion consisting of posterior reduction, short-segment fusion, and delayed staged mini-open anterior short-segment fusion.
  
  
  BACKGROUND
  The surgical treatment of thoracolumbar burst fractures remains controversial. In attempting to combine the advantages of posterior procedures, including initial correction of kyphosis and early decompression, and those of anterior procedures, including direct decompression and restoration of anterior column support, a combined posterior and delayed staged anterior procedure seems to be a reasonable choice. However, conventional combined procedures are invasive.
  
  
  METHODS
  We prospectively selected 28 consecutive patients with single thoracolumbar burst fracture for circumferential short-segment fusion consisting of posterior reduction, short-segment fusion, and delayed staged mini-open anterior short-segment fusion. The pedicle screw systems were removed after confirmation of posterior bony fusion to preserve as many motion segments as possible in those patients who could be treated with circumferential monosegmental fusion. Radiographic and clinical assessment of 28 patients who received this treatment was carried out.
  
  
  RESULTS
  The mean loss of correction of kyphosis between the time of the combined procedure and final follow-up was 3.7 degrees (range, 0 to 10.2 degrees). Bony fusion was eventually achieved in all patients. There were 15 cases with monosegmental and 13 cases with bisegmental circumferential fusion. All 10 patients with initial neurological deficit improved by at least 1 Frankel grade: 3 improved by 1 grade, 5 improved by 2 grades, and 2 improved by 3 grades. In total, 27 patients, who were P1 or P2 on the Denis pain scale, were considered to have obtained clinically satisfactory results.
  
  
  CONCLUSIONS
  This combined procedure is less invasive than the conventional combined one, and finally achieves shorter stabilization, resulting in preservation of motion segments. It thus seems to be a reasonable treatment option for thoracolumbar burst fractures.
authors: Department of Orthopaedic Surgery, Imakiire General Hospital, 4-16 Shimotatsuo, Kagoshima, Japan. tofuku@m2.kufm.kagoshima-u.ac.jp
authors: Katsuhiro
authors: K
authors: Tofuku
authors: Hiroaki
authors: H
authors: Koga
authors: Kosei
authors: K
authors: Ijiri
authors: Yasuhiro
authors: Y
authors: Ishidou
authors: Takuya
authors: T
authors: Yamamoto
authors: Michihisa
authors: M
authors: Zenmyo
authors: Kazunori
authors: K
authors: Yone
authors: Setsuro
authors: S
authors: Komiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult