Abstract
Thirty-one patients with an average age of 27 years were included in this study to analyze the short-term results of simultaneous anterior and posterior approaches in the treatment of late complications of thoracolumbar fractures. The complications treated were pseudoarthrosis and malunion resulting in neurologic compromise and pain. There were 20 burst fractures, 2 fracture/dislocations, and 9 compression fractures in this group. Average preoperative Sagittal Index was 35°, which improved to an average of 4° after surgical treatment. The average Motor Index Score improved from 90 to 98 after surgery. Average follow-up was 16 months. Average estimated blood loss was 2000 ml and average operation time was 5 h. It was concluded that the late problems associated with thoracolumbar fractures can be addressed quite adequately with simultaneous anterior and posterior approaches. The simultaneous anterior and posterior approach is associated with decreases in operating time, blood loss, and hospital stay. Technical advantages of the simultaneous technique include elimination of acute instability between the stages, protection against dislodgment of the graft, and application of the posterior instrumentation under complete visualization of the anterior graft.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bradford DS, Ganjavian S, Antonius D, Winter RB, Lonstein JE, Moe JH (1982) Anterior strut grafting for the treatment of kyphosis. J Bone Joint Surg [Am] 64:680
Bradford DS, Winter RB, Lonstein JE, Moe JH (1977) Techniques for anterior spinal surgery for the management of kyphosis. Clin Orthop 128:129
Denis F (1983) The three-column spine and its significance in the classification of acute thoracolumbar spine injuries. Spine 8:817
Dick J, Boachie O, Wilson M (1992) One stage versus two stage anterior and posterior spinal reconstruction in adults: comparison of outcomes including nutritional status, complication rates, hospital costs, and other factors. Spine 17: S 310
Farcy JPC, Weidenbaum M, Glassman SD (1990) The sagittal index in the management of thoracolumbar burst fractures. Spine 15:958
Ferguson RL, Allen BL (1983) A mechanistic classification of thoracolumbar spine fractures. Clin Orthop 189:77
Floman Y, Farcy J-P, Argenson C (1994) Thoraco-lumbar fractures. Raven Press, New York, pp 449–461
Fountain SS (1979) A single-staged combined surgical approach for vertebral resections. J Bone Joint Surg [Am] 61:1011
Gurr KR, McAfee PC, Shih CM (1988) Biomechanical analysis of anterior and posterior instrumentation systems after corpectomy. J Bone Joint Surg [Am] 70:1182
Heinig C (1984) In: ER Luque (ed) Segmental spinal instrumentation. Slack, Thorofare, NI
Holdsworth FW (1963) Fractures, dislocations and fracture-dislocations of the spine. J Bone Joint Surg [Br] 45:6
Holdsworth FW (1970) Fractures, dislocations and fracture-dislocations of the spine. J Bone Joint Surg [Am] 52: 1534
Lucas JL, Durcker TD (1979) Motor classification of spinal cord injuries with mobility, morbidity and recovery indices. Am J Surg 45:151
Malcolm BW, Bradford DS, Winter RB, Chou SN (1981) Post-traumatic kyphosis. J Bone Joint Surg [Am] 63: 891
Mandenbaum BR, Tolo VT, McAfee PC, Bursest P (1988) Nutritional deficiencies after staged anterior and posterior spinal reconstructive surgery. Clin Orthop 234:5
McAfee PC, Bohlman HH, Yuan HA (1985) Anterior decompression of traumatic thoracolumbar fractures with incomplete neurologic deficit using a retroperitoneal approach. J Bone Joint Surg [Am] 67:89
McBride GG, Bradford DS (1983) Vertebral body replacement with femoral neck allograft and vascularized rib strut graft: a technique for treating post-traumatic kyphosis with neurologic deficit. Spine 8:406
Nicoll EA (1949) Fracture of the dorso-lumbar spine. J Bone Joint Surg [Br] 31:376
O'Brien JP, Dawson MHO, Harrod CW, Monbarger G, Speck G, Weatherly CR (1986) Simultaneous combined anterior and posterior fusion: a surgical solution for failed spinal surgery with a brief review of the first 150 patients. Clin Orthop 203:191
Panjabi MM (1978) In: White AA, Panjabi MM (eds) Clinical biomechanics of the spine. Lippincott, Philadelphia, p 192
Spencer DL, DeWald RL (1979) Simultaneous anterior and posterior surgical approach to the thoracic and lumbar spine. Spine 4:29
Spivak JM, Neuwirth MG, Giordano CP, Bloom N (1994) The perioperative course of combined anterior and posterior spinal fusion. Spine 19:520
Streitz W, Brown JC, Bonnet CA (1977) Anterior fibular struct grafting in the treatment of kyphosis. Clin Orthop 128:140
Transfeldt EE, White D, Bradford DS, Roche B (1990) Delayed anterior decompression in patients with spinal cord and cauda equina injuries of the thoracolumbar spine. Spine 15:953
Whitesides TE (1977) Traumatic kyphosis of the thoracolumbar spine. Clin Orthop 128:78
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Acaroglu, E.R., Schwab, F.J. & Farcy, J.P. Simultaneous anterior and posterior approaches for correction of late deformity due to thoracolumbar fractures. Eur Spine J 5, 56–62 (1996). https://doi.org/10.1007/BF00307828
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00307828