Single-Centre experience with independent anterior retroperitoneal decompression and reconstruction of burst lumbar fractures

Document Type : Original Articles

Authors

1 Neurosurgery department, faculty of medicine, Tanta university

2 Neurosurgery department, Faculty of medicine, Tanta university.

3 Neurosurgery Department, Faculty of Medicine, Tanta University, Egypt

Abstract

Background: A common spinal injury that causes instability, kyphotic deformities, and intra-canal bone pieces that cause neurological troubles and necessitate surgical decompression and reconstruction is a lumbar burst fracture. The ideal surgical technique is still debatable.

Purpose: This study was set to retrospectively assess our center's experience with surgical treatment for some kinds of unstable three-column thoracolumbar fractures, which is achieved via a single-stage, independent anterior surgery with anterior fixation.

Methods: Twenty patients with traumatic lumbar burst fracture with anterior canal compromise were included between July 2021 and July 2023. All patients had surgical decompression and stabilization using a standalone anterior approach.

Results: The L1 vertebra was the site of 40% of the fractures. A minimum of six months were spent monitoring every patient. patient had the thoracolumbar injury classification and severity score (TLICS score) with a mean of 7.4, and the Oswestry Disability Index (ODI) ranged from 80–90 before surgery and 21–50 after surgery. 75% of neurologically affected patients improved at least one grade according to the Frankel classification scale of neurological affection after surgery, except 3 cases with no improvement of the preoperative A-score. The kyphotic angle showed improvement from the mean angle 9.5˚ before surgery to the mean angle 2˚, 8˚ after surgery.

Conclusion: The direct anterior decompression of neural elements with contemporary anterior spinal instrumentation and reconstruction improves segmental angulation without violation of the intact posterior column and has a shorter fusion segment compared to posterior fusion. It also has acceptable operation time and perioperative complications.

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