[Case-control study on therapeutic effects between posterior corpectomy, decompression and reconstruction and combined anterior-posterior surgery for the treatment of severe thoracolumbar fractures with incomplete paraplegia].

OBJECTIVE

To compare the clinical outcome between posterior corpectomy, decompression and reconstruction and combined anterior-posterior surgery in the treatment of severe thoracolumbar three column fractures with incomplete paraplegia, and to provide a basis for procedure selection.

METHODS

Clinical and radiographic results of posterior corpectomy, decompression and reconstruction (group A) and combined anterior-posterior surgery (group B) in the treatment of severe thoracolumbar three column fractures with incomplete paraplegia were analyzed retrospectively from January 2008 to December 2012. In group A, there were 18 patients (10 males and 8 females). The fractures were located on T11 in 1 case, T12 in 5 cases, L1 in 6 cases and L2 in 6 cases. In group B, there were 15 patients (9 males and 6 females). The fractures were located on T1 in 1 case, T12 in 5 cases, L1 in 5 cases and L2 in 4 cases. Neurological status was judged by Frankel grades. The X-ray and CT were used for evaluation of the restoration of anterior height of the fractured vertebral body, the correction of Cobbs angle, the decompression scope of spinal canal and the fusion. Complications related to operation were also considered. Results: The followup periods ranged from 12 to 18 months (averaged 16 months). The mean operation time, perioperative bleeding, postoperative drainage were (200 ± 43) min, (1100 ± 344) ml, and (400 ± 112) ml respectively in group A; and (290 ± 68) min, (1 500 ± 489) ml, (900 ± 269) ml respectively in group B. There was statistically significant difference between groups A and B (P < 0.05). There were significant improvements in anterior height of fractured vertebral body and Cobbs angle after operation. But there was no significant difference between groups A and B (P > 0.05). In Frankel grades, all patients had one grade or more improvement postoperatively. There was no significant difference between two groups (P > 0.05).

CONCLUSION

Treatment of thoracolumbar vertebra burst fractures with subtotal vertebrectomy, decompression and reconstruction of anterior column through posterior approach has a similar clinical result compared to the operation through combined anterior and posterior approach, but the posterior surgery decreased surgical trauma. It is an effective and safe surgical method.