STUDY DESIGN: A prospective study was performed.
OBJECTIVE: To assess an unusual technique for corpectomy and expandable cage placement via single-stage posterior approach in acute thoracic or lumbar burst fractures.
SUMMARY AND BACKGROUND DATA: Burst fractures represent 10% to 20% of all spine injuries at or near the thoracolumbar junction, and can cause neurologic complications and kyphotic deformity. The goal of surgical intervention is to decompress the neural elements, restore vertebral body height, correct angular deformity, and stabilize the columns of the spine.
METHODS: The study comprised 14 patients (8 women and 6 men aged 40.3 years) who had 1 spinal burst fracture between T8 and L4 and who underwent single-stage posterior corpectomy, circumferential reconstruction with expandable-cage placement, and transpedicle screwing between January 2003 and May 2005. Neurologic status was classified using the American Spinal Injury Association (ASIA) impairment scale and functional outcomes were analyzed using a visual analogue scale (VAS) for pain. The kyphotic angle (alpha) and lordotic angle (beta) were measured in the thoracic or thoracolumbar and lumbar regions, respectively. RESULTS.: The mean follow-up time was 24 months (range, 12-48 months). Neurologic status was in 7 patients (preop: ASIA-E, postop: unchanged), 2 patients (preop: ASIA-D, postop: 1 unchanged, 1 improved to ASIA-E), 3 patients (preop: ASIA-C, postop: 2 improved to ASIA-D, 1 improved to ASIA-E), 2 patients (preop: ASIA-B, postop: 1 improved to ASIA-C, 1 unchanged). The mean operative time was 187.8 minutes. The mean blood loss was 596.4 mL. Regarding postoperative complications, 1 patient experienced transient worsening of neurologic deficits and 1 patient developed pseudarthrosis. The mean preoperative VAS score was 8.21 and the mean postoperative VAS score was 2.66 (P < 0.05). The mean preoperative kyphotic angle for the 11 individuals with the thoracic or thoracolumbar burst fractures was 24.6 degrees and the mean preoperative lordotic angle for the 3 individuals with lumbar burst fractures was 10.6 degrees. The corresponding values at 12 months postsurgery were 17.1 degrees and 13.6 degrees.
CONCLUSION: This single-stage posterior approach for acute thoracic and lumbar burst fractures offers some advantages over the classic combined anterior-posterior approach. The results from this small series suggest that a single-stage posterior approach should be considered in select cases.
