Anterior decompression and stabilization of thoracolumbar burst fractures using the Slot-Zielke-device.

A retrospective study was performed on 62 patients treated for thoracolumbar burst fractures. The Fracture Study Protocol of the Scoliosis Research Society was used for data collection. The first group consisted of 29 patients, treated between July 1983 and November 1986 with an one-stage operation consisting of anterior decompression by subtotal vertebrectomy, reduction and stabilization with the Slot-Zielke device. The mean follow-up was 3.1 years. The second group consisted of 33 patients, who were treated between November 1986 and November 1988. In this second group treatment was performed by an anterior decompression by subtotal vertebrectomy, reduction and stabilization with the Slot-Zielke-device, in the same session followed by an additional posterior spondylodesis and instrumentation with the Zielke D.K.S.-system or by the Cotrel-Dubousset compression-rod system. Mean follow-up of this second group was 1.7 years. In all patients bony union occurred. Loss of reduction of more than 5 degrees occurred in 41% of the patients of the first group, but in only one patient (3%) of the second group. In both groups most patients with incomplete neurologic lesions improved postoperatively and were upgraded one or two steps on the Frankel-scale. No patient showed neurologic deterioration after surgery. In both groups a high percentage of patients were painfree at follow-up. The complication rate in both groups was low, despite the rather difficult anterior approach. Because of the high rate of loss of reduction in the first group of 29 patients and the low degree of flexion-bending loading and torsional stability in biomechanical evaluation in vitro of the Slot-Zielke device on human cadaver spine, an additional posterior stabilization of the spine after an anterior approach for anterior- and middle-column fractures should be considered.