Combined posteroanterior fusion versus transforaminal lumbar interbody fusion (TLIF) in thoracolumbar burst fractures.
BACKGROUND
The optimal treatment strategy for burst fractures of the thoracolumbar junction is discussed controversially in the literature. Whilst 360° fusion has shown to result in better radiological outcome, recent studies have failed to show its superiority concerning clinical outcome. The morbidity associated with the additional anterior approach may account for these findings. The aim of this prospective observational study was therefore to compare two different techniques for 360° fusion in thoracolumbar burst fractures using either thoracoscopy or a transforaminal approach (transforaminal lumbar interbody fusion (TLIF)) to support the anterior column.


METHODS
Posterior reduction and short-segmental fixation using angular stable pedicle screw systems were performed in all patients as a first step. Monocortical strut grafts were used for the anterior support in the TLIF group, whilst tricortical grafts or titanium vertebral body replacing implants of adjustable height were used in the combined posteroanterior group. At final follow-up, the radiological outcome was assessed by performing X-rays in a standing position. The clinical outcome was measured using five validated outcome scores. The morbidity associated with the approaches and the donor site was assessed as well.


RESULTS
There were 21 patients in the TLIF group and 14 patients in the posteroanterior group included. The postoperative loss of correction was higher in the TLIF group (4.9°±8.3° versus 3.4°±6.4°, p>0.05). There were no significant differences regarding the outcome scores between the two groups. There were no differences in terms of return to employment, leisure activities and back function either. More patients suffered from donor-site morbidity in the TLIF group, whilst the morbidity associated with the surgical approach was higher in the posteroanterior group.


CONCLUSIONS
The smaller donor-site morbidity in the posteroanterior group is counterbalanced by an additional morbidity associated with the anterior approach resulting in similar clinical outcome. Mastering both techniques will allow the spine surgeon to be more flexible in specific situations, for example, in patients with neurological deficits or severe concomitant thoracic trauma.
Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstraße 35, Innsbruck, Austria. rene.schmid@uki.at
Rene
R
Schmid
Richard Andreas
RA
Lindtner
Markus
M
Lill
Michael
M
Blauth
Dietmar
D
Krappinger
Christian
C
Kammerlander
D000328:Adult; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery*; D008161:Lumbosacral Region / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013117:Spinal Cord Compression / Q000601:surgery*; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery*; D055815:Young Adult