Decompression and circumferential stabilization of unstable spinal fractures.

A technique of anterior decompression of the spinal canal with anterior strut grafts, followed by posterior instrumentation and local fusion, is described in a group of 18 patients with unstable thoracolumbar fractures. All patients were found to have greater than 50% encroachment of the spinal canal and a preoperative kyphosis of 21.8 degrees. At follow-up 81% of patients with incomplete neurological lesions improved at least one Frankel Grade. Residual encroachment on the spinal canal was 4.6% and at follow-up the kyphotic angle was 17.1 degrees. Complications included one anterior graft loosening (not requiring revision), three loosened rods, only one of which required revision, and one fractured Harrington rod which did not require revision. The authors conclude that this technique is an effective and safe method for treating unstable thoracolumbar injuries and is recommended if anterior instrumentation is unavailable.