Abstract
Anterior only procedure for stable thoraco-lumbar burst fractures is controversial.
Prospective collection of clinical and radiological data in stable burst fractures with neurological deficit undergoing anterior only decompression and stabilisation with 2-year follow-up.
14 consecutive patients (8 females, 6 males) with two-column thoracolumbar burst fracture and neurological deficit underwent anterior corpectomy/hemi-corpectomy and instrumentation, from February 2007 to February 2009.
Radiological data included classification of fracture (AO classification), kyphus angle and degree of canal compromise. Post-operative CT scans done to assess radiological improvement.
Clinical data included neurological deficit at presentation, improvement or changes in neurology, length of surgery, estimated blood loss, post-operative complications and length of stay.
Commonest mechanism was fall from height. 10 patients had incomplete burst fractures amenable to hemi-corpectomy. 8 of our patients were ASIA D, 4 were ASIA C or lower. They all improved by at least one grade. 2 patients had identical ASIA grade pre and post operatively. Pre-operative spinal canal compromise averaged 52.6% and vertebral body height loss averaged 48.9%. The mean kyphotic angles improved from 19.6° to 7.9 °. There were two cases with minor injury to the diaphragm, one developing a pneumothorax. Mean length of surgery and hospital stay were 4hours and 21minutes and 11.8 days respectively.
The fractures in which the top part is burst and causing canal compromise, could be dealt with by top hemi-corpectomy requiring smaller approach. One stage anterior – only stabilization can yield successful clinical results.
