title: Risk factors for supplementary posterior instrumentation after anterolateral decompression and instrumentation in thoracolumbar burst fractures.
abstract: BACKGROUND
  In spite of the established benefits of anterolateral decompression and instrumentation (ALDI) for thoracolumbar burst fractures (TLBF), the indications for supplementary posterior instrumentation remain unclear.
  
  
  METHODS
  A retrospective review of clinical and radiographic data of a prospective cohort of 73 patients who underwent ALDI for TLBF from T12 to L4.
  
  
  RESULTS
  The mean age of the cohort was 42 ± 15 years, with 49 males and 24 females. Forty-six patients had neurological deficit, and 27 were intact. Owing to symptomatic settling, supplemental posterior instrumentation was performed in 7 out of 73 patients. The age of patients requiring supplemental posterior instrumentation (59 ± 14 years) exceeded that of patients who did not (41 ± 16, p=0.004). Otherwise, the patients who required posterior instrumentation were comparable to those treated with ALDI in terms of body mass index (BMI), American Spinal Injury Association (ASIA) scores on admission and follow-up, residual spinal canal, and local kyphosis on admission and follow-up. The posterior ligamentous complex (PLC) integrity was assessed in 38 patients in whom the MRI scans were retrievable, 31 successfully treated with ALDI, and all 7 undergoing supplementary posterior instrumentation. Subgroup analysis demonstrated that there was no difference in the incidence of PLC disruption between the 2 groups (p=0.257).
  
  
  CONCLUSIONS
  Secondary supplemental posterior instrumentation was deemed necessary in 10% of cases following ALDI. Age was the only significant risk factor predicating supplemental posterior instrumentation.
authors.affiliation: Departments of Neurosurgery, Rutgers-New Jersey Medical School, Newark, USA. Electronic address: patrick-hitchon@uiowa.edu.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Hitchon
authors.affiliation: Department of Neurology & Neurosciences, Rutgers-New Jersey Medical School, Newark, USA.
authors.forename: Wenzhuan
authors.initials: W
authors.lastname: He
authors.affiliation: Departments of Neurosurgery, Rutgers-New Jersey Medical School, Newark, USA.
authors.forename: Nader S
authors.initials: NS
authors.lastname: Dahdaleh
authors.affiliation: Departments of Radiology, University of Iowa Carver College of Medicine, Iowa City, USA.
authors.forename: Toshio
authors.initials: T
authors.lastname: Moritani
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anterior decompression; Anterior instrumentation; Posterior instrumentation; Posterior ligamentous complex; Thoracolumbar burst fracture