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Abstract
Summary
Management of thoracolumbar fractures is one of the most controversial areas in modern spinal surgery either operative or non-operative treatement. Operative management varies according to many factors mainly fracture morphology, neurologic status, and surgeon preference play major roles in deciding upon anterior or posterior approach .
A review of literature provides detailed comprehension of this subject. It started by brief historical review of the different ancient and recent approaches and instrumentations correlated to management of thoracolumbar spine fractures , this is followed by detailed description of the normal anatomy of the thoracolumbar junction and the surrounding important structures. Biomechanics of the spine and factors affect spine instability under normal condition and during trauma and its correlation with subsequent plan of management of these fractures have been mentioned also.
This research is a retrospective comparative case series study based on forty patients had unstable thoracolumbar spine fractures and under went surgical decompression and fixation, half of them operated via anterolateral approach and the other half operated via posterior approach. pre-operative parameters as age, sex, type of trauma, pre-operative neurological and functional assessment added to this different pre-operative radiological parameters, all were clearly studied and documented.
Then the clinical recovery of these patients was assessed post-operatively through objective follow-up of neurological and radiological recovery, then all pre and post-operative resuts had analyzed considering neurological assessment depending on Frankel paraplegia grading scale which revealed better neurological recovery and reduced neurological deficits with anterolateral approach, functional recovery consisted of post-operative assessment of pain and work status using modified Prolo Functional and Economic Rating Scale revealed that scoring was better in anterolateral group as the majority of cases in this group had excellent to good functional outcome (95%).
Radiological recovery in anterolateral group were clearly stated in relation with clinical and functional recovery in the form of decreased neural canal compromise as (15%)of patients of this group had post-operative totally cleared neural canal, also post-operative kyphotic deformity improved as the mean post-operative Cobb angle at the final follow-up period for anterolateral and posterior groups was 7 0 and 9.10 respectively.
The discussion analyses these results together and comparing them with the results of series published by other authors on the management of unstable thoracolumbar spine fractures via anterolateral approach versus posterior approach, depending on clinical and radiological outcome of each surgical approach.
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