title: Additional anterior plating enhances fusion in anteroposteriorly stabilized thoracolumbar fractures.
abstract: BACKGROUND
  To prospectively evaluate the potential radiological and clinical effect of the additional application of an anterior plate in anteroposteriorly stabilized thoracolumbar fractures.
  
  
  METHODS
  75 consecutive patients with unstable thoracolumbar fractures underwent posterior (internal fixator) and anterior stabilization (corpectomy cage with local autologous bone grafting). 40 (53.3%) patients received an additional anterior plate (Group A), while 35 (46.6%) (Group B) did not. Plain X-rays and CT-scans were obtained pre- and postoperatively, after 12 months and at the last follow-up (mean 32 months, range 22-72). Loss of reduction, cage subsidence to adjacent vertebrae, fusion rates and clinical results were evaluated.
  
  
  RESULTS
  66 (87%) patients (36 Group A; 30 Group B) were available for follow-up. Patients in both groups were comparable regarding age, gender, comorbidities, localization and classification of fracture. Average loss of reduction was 2.4° in Group A, and 3.1° in Group B (not significant). Cage subsidence did not differ significantly between both groups, too. However, after 12 months the rate of continuous osseous bridging between endplates was significantly higher in Group A (63% vs. 25%) (p<0.05). After 32 months this difference was even higher (81% vs. 33%) (p<0.001). The bony fusion mass was located beneath or around the anterior plate in 94% of patients. There was no significant difference in clinical outcome.
  
  
  CONCLUSIONS
  Additional anterior plating in anteroposteriorly stabilized thoracolumbar fractures leads to significant faster fusion but does neither influence reduction loss nor cage subsidence. The anterior plate serves as a pathway for bone growth and increases biomechanical stability, resulting in a higher fusion rate.
authors: Center for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, D-60389 Frankfurt am Main, Germany. Electronic address: klaus.schnake@bgu-frankfurt.de.
authors: Klaus John
authors: KJ
authors: Schnake
authors: Center for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, D-60389 Frankfurt am Main, Germany. Electronic address: sstavridis@yahoo.com.
authors: Stavros I
authors: SI
authors: Stavridis
authors: Center for Dialysis, Königin Elisabeth Herzberge Krankenhaus, Berlin, Herzbergstraße 79, D-10365 Berlin, Germany. Electronic address: s.krampe@keh-berlin.de.
authors: Sebastian
authors: S
authors: Krampe
authors: Center for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, D-60389 Frankfurt am Main, Germany. Electronic address: frank.kandziora@bgu-frankfurt.de.
authors: Frank
authors: F
authors: Kandziora
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: CT-scan; Combined anteroposterior stabilization; Corpectomy cage; Spinal fusion; Thoracolumbar fractures