The role of combined posterior and anterolateral retroperitoneal approach in the treatment of posttraumatic burst lumbar fractures

 

 Permissions and Reprints

Context: Combined posterior and anterolateral retroperitoneal approach is very important for the treatment of unstable burst lumber fractures with retropulsed fragments. Aims: The aim of the study is to evaluate the role of combined posterior and anterolateral retroperitoneal approach in the treatment of unstable burst lumber fractures. Settings and Design: This is a retrospective clinical case series study. Patients and Methods: This study was conducted on 41 patients with unstable lumber burst fractures with retropulsed fragment. Frankel scale score and Denis pain score were used to evaluate the functional outcome. All patients were surgically treated using combined posterior and anterolateral retroperitoneal approach. They were followed for 1 year postoperatively. Statistical Analysis: Using SPSS version 21, data were presented as mean ± standard deviation, and percentage and paired sample and Wilcoxon signed-rank tests were used for data analysis. Results: the functional state of all patients improved after surgery. According to the Frankel and Denis pain scores, there was a significant improvement in patients' scores postoperatively compared to preoperative ones (P = 0.001). Visceral manifestations were present in 16 cases (36.6%) with complete improvement postoperatively except two cases. There is a significant improvement as regards pre- and postoperative regional kyphotic angle (9.12 ± 10.03) and vertebral body height (3.14 ± 0.37). Unintended durotomy occurred in six cases treated by stitching using absorbable sutures and fat graft. Wound infection was present in two cases treated by antibiotics and daily dressing. A solid fusion was achieved in all cases. Conclusions: Combined posterior and anterolateral retroperitoneal approach is feasible and effective in surgical exposure and treatment of unstable burst lumber fractures with retropulsed fragments.

Financial support and sponsorship

Nil.

Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

• References

• 1 Sasso RC, Renkens K, Hanson D, Reilly T, McGuire RA Jr., Best NM, et al. Unstable thoracolumbar burst fractures: Anterior-only versus short-segment posterior fixation. J Spinal Disord Tech 2006;19:242-8.
• 2 Been HD, Bouma GJ. Comparison of two types of surgery for thoraco-lumbar burst fractures: Combined anterior and posterior stabilisation vs. posterior instrumentation only. Acta Neurochir (Wien) 1999;141:349-57.
• 3 Aydinli U, Karaeminoǧullari O, Tişkaya K, Oztürk C. Dural tears in lumbar burst fractures with greenstick lamina fractures. Spine (Phila Pa 1976) 2001;26:E410-5.
• 4 Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8:817-31.
• 5 Denis F. Thoracolumbar spine trauma. In: Moes's Textbook of Scoliosis and Other Spinal Deformities. 3rd ed. Philadelphia: W.B. Saunders; 1995. p. 577-89.
• 6 Enis F. Spinal instability as defined by the three column spine concept in acute spinal trauma. Clin Orthop1984;189:65-76.
• 7 Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia 1969;7:179-92.
• 8 Rihn JA, Anderson DT, Harris E, Lawrence J, Jonsson H, Wilsey J, et al. Areview of the TLICS system: A novel, user-friendly thoracolumbar trauma classification system. Acta Orthop 2008;79:461-6.
• 9 Wilke HJ, Kemmerich V, Claes LE, Arand M. Combined anteroposterior spinal fixation provides superior stabilisation to a single anterior or posterior procedure. J Bone Joint Surg Br 2001;83:609-17.
• 10 Gertzbein SD. Scoliosis research society. Multicenter spine fracture study. Spine (Phila Pa 1976) 1992;17:528-40.
• 11 Hitchon PW, Torner J, Eichholz KM, Beeler SN. Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures. J Neurosurg Spine 2006;5:117-25.
• 12 Sin E, Kim H, Lee C, Ha H, Jung C. Results of combined 360° fusion versus posterior fixation alone for thoracolumbar burst fractures. Korean J Neurotrauma 2013;9:52-6.
• 13 Graillon T, Rakotozanany P, Blondel B, Adetchessi T, Dufour H, Fuentes S, et al. Circumferential management of unstable thoracolumbar fractures using an anterior expandable cage, as an alternative to an iliac crest graft, combined with a posterior screw fixation: Results of a series of 85 patients. Neurosurg Focus 2014;37:E10.
• 14 Esses SI, Botsford DJ, Kostuik JP. Evaluation of surgical treatment for burst fractures. Spine (Phila Pa 1976) 1990;15:667-73.
• 15 Samudrala S, Khoo LT, Rhim SC, Fessler RG. Complications during anterior surgery of the lumbar spine: An anatomically based study and review. Neurosurg Focus 1999;7:e9.