Clinical study| Volume 75, P11-18, May 2020

Download started.


Thoracolumbar burst fractures in patients with neurological deficit: Anterior approach versus posterior percutaneous fixation with laminotomy

Published:April 02, 2020DOI:


      • Spinal canal decompression through small laminectomy and percutaneous pedicle screw fixation offers excellent clinical and radiological improvement.
      • Furthermore, this can be safer and more effective surgical option compared to anterior corpectomy and fusion in the thoracolumbar burst fractures.
      • As far as I know, no paper has been directly compared these two methods.



      Thoracolumbar burst fractures (TLBFs) are the most common spinal trauma; however, their appropriate management has not yet been determined. In this study, we aimed to compare the clinical and radiological results of percutaneous pedicle screw fixation (PPSF) following posterior decompression technique versus anterior corpectomy and fusion technique for the treatment of TLBFs.


      A total of 46 patients (2002–2015) with TLBFs were included in this study. The inclusion criteria were a single-level Magerl type A3 burst fracture of the thoracolumbar junctional spine (T12–L2). The patients were divided into two groups; Group A (22 patients) underwent anterior corpectomy and fusion, and Group B (24 patients) underwent PPSF after posterior decompression. Anterior corpectomy and fusion surgery were performed in 22 cases before April 2009, and PPSF following posterior decompression technique was used in 24 cases since then. For radiological assessment, the kyphosis angle was measured preoperatively, early postoperatively, and at the last follow-up using the Cobb angle. Mean correction of the Cobb angle after surgery, and loss of correction between the immediate postoperative and final Cobb angle were calculated accordingly. All neurological deficits were identified in the initial evaluation and graded using the American Spinal Injury Association (ASIA) grading system. Perioperative parameters including operation time, amount of blood loss, and mean hospital stay were also evaluated.


      The patients comprised 17 males and 5 females in Group A and 13 males and 11 females in Group B. In terms of the involved levels, there were three cases of T12, twelve L1, and seven L2 in Group A and one case of T12, thirteen L1, and ten L2 in Group B. The mean follow-up duration was 44.9 months in Group A and 14.7 months in Group B. The kyphotic angle was significantly corrected after surgery by 6.4° in Group A (p = 0.001) and 9.2° in Group B (p < 0.001). Among patients with neurological deficit, 11 of 15 in Group A and 20 of 23 in Group B demonstrated improvement by at least one ASIA grade at the final observation. However, there was no significant difference in neurological improvement between the two groups (p = 0.13). Mean operation time was significantly shorter (p < 0.001) and mean blood loss was significantly less (p < 0.001) in Group B than in Group A. Mean hospital stay was also significantly shorter in Group B (p < 0.001).


      Spinal canal decompression through small laminectomy followed by PPSF in the treatment of TLBFs with neurological deficits offers excellent clinical and radiological improvement as well as biomechanical stability. Furthermore, this can be a safe and effective surgical option with the advantage of less invasiveness in the treatment of TLBFs.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Alanay A.
        • Acaroglu E.
        • Yazici M.
        • Oznur A.
        Surat A: short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure?.
        Spine (Phila Pa 1976). 2001; 26: 213-217
        • Alvine G.F.
        • Swain J.M.
        • Asher M.A.
        • Burton D.C.
        Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis: case series and literature review.
        J Spinal Disord Tech. 2004; 17: 251-264
        • Carl A.L.
        • Tromanhauser S.G.
        • Roger D.J.
        Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations.
        Spine (Phila Pa 1976). 1992; 17: S317-S324
        • Castro W.H.
        • Halm H.
        • Jerosch J.
        • Malms J.
        • Steinbeck J.
        • Blasius S.
        Accuracy of pedicle screw placement in lumbar vertebrae.
        Spine (Phila Pa 1976). 1996; 21: 1320-1324
        • Chen H.H.
        • Wang W.K.
        • Li K.C.
        • Chen T.H.
        Biomechanical effects of the body augmenter for reconstruction of the vertebral body.
        Spine (Phila Pa 1976). 2004; 29: E382-E387
        • Cho D.Y.
        • Lee W.Y.
        • Sheu P.C.
        Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation.
        Neurosurgery. 2003; 53 (discussion 1360–1351): 1354-1360
        • Dai L.Y.
        • Yao W.F.
        • Cui Y.M.
        • Zhou Q.
        Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases.
        J Trauma. 2004; 56: 348-355
        • Denis F.
        The three column spine and its significance in the classification of acute thoracolumbar spinal injuries.
        Spine (Phila Pa 1976). 1983; 8: 817-831
        • Gao B.
        • Xing R.
        • Kong Q.
        • Song Y.
        • Liu H.
        • Li T.
        • et al.
        Subtotal corpectomy and intervertebral bone grafting through posterior approach alone in treatment of thoracolumbar burst fracture or thoracolumbar fracture-dislocation.
        Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012; 26: 542-545
        • Huang Z.Y.
        • Ding Z.Q.
        • Liu H.Y.
        • Fang J.
        • Liu H.
        • Sha M.
        Anterior D-rod and titanium mesh fixation for acute mid-lumbar burst fracture with incomplete neurologic deficits: a prospective study of 56 consecutive patients.
        Indian J Orthop. 2015; 49: 471-477
        • Kim G.W.
        • Jang J.W.
        • Hur H.
        • Lee J.K.
        • Kim J.H.
        • Kim S.H.
        Predictive factors for a kyphosis recurrence following short-segment pedicle screw fixation including fractured vertebral body in unstable thoracolumbar burst fractures.
        J Korean Neurosurg Soc. 2014; 56: 230-236
        • Kurz L.T.
        • Garfin S.R.
        • Booth R.E.
        Jr.: Harvesting autogenous iliac bone grafts. A review of complications and techniques.
        Spine (Phila Pa 1976). 1989; 14: 1324-1331
        • Lee J.K.
        • Jang J.W.
        • Kim T.W.
        • Kim T.S.
        • Kim S.H.
        • Moon S.J.
        Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures: is it effective? Comparative study with open short-segment pedicle screw fixation with posterolateral fusion.
        Acta Neurochir (Wien). 2013; 155 (discussion 2312): 2305-2312
        • Leferink V.J.
        • Zimmerman K.W.
        • Veldhuis E.F.
        • ten Vergert E.M.
        • ten Duis H.J.
        Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients.
        Eur Spine J. 2001; 10: 517-523
        • Ni W.F.
        • Huang Y.X.
        • Chi Y.L.
        • Xu H.Z.
        • Lin Y.
        • Wang X.Y.
        • et al.
        Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures.
        J Spinal Disord Tech. 2010; 23: 530-537
        • Palmisani M.
        • Gasbarrini A.
        • Brodano G.B.
        • De Iure F.
        • Cappuccio M.
        • Boriani L.
        • et al.
        Minimally invasive percutaneous fixation in the treatment of thoracic and lumbar spine fractures.
        Eur Spine J. 2009; 18: 71-74
        • Roy-Camille R.
        • Saillant G.
        • Mazel C.
        Plating of thoracic, thoracolumbar, and lumbar injuries with pedicle screw plates.
        Orthop Clin North Am. 1986; 17: 147-159
        • Sanderson P.L.
        • Fraser R.D.
        • Hall D.J.
        • Cain C.M.
        • Osti O.L.
        • Potter G.R.
        Short segment fixation of thoracolumbar burst fractures without fusion.
        Eur Spine J. 1999; 8: 495-500
        • Siebenga J.
        • Leferink V.J.
        • Segers M.J.
        • Elzinga M.J.
        • Bakker F.C.
        • Haarman H.J.
        • et al.
        Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment.
        Spine (Phila Pa 1976). 2006; 31: 2881-2890
        • Sihvonen T.
        • Herno A.
        • Paljarvi L.
        • Airaksinen O.
        • Partanen J.
        Tapaninaho A: local denervation atrophy of paraspinal muscles in postoperative failed back syndrome.
        Spine (Phila Pa 1976). 1993; 18: 575-581
        • Wang S.T.
        • Ma H.L.
        • Liu C.L.
        • Yu W.K.
        • Chang M.C.
        • Chen T.H.
        Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine? A prospective, randomized study.
        Spine (Phila Pa 1976). 2006; 31 (discussion 2653): 2646-2652
        • Weiner B.K.
        • Walker M.
        • Brower R.S.
        McCulloch JA: microdecompression for lumbar spinal canal stenosis.
        Spine (Phila Pa 1976). 1999; 24: 2268-2272
        • Wiesner L.
        • Kothe R.
        • Schulitz K.P.
        • Ruther W.
        Clinical evaluation and computed tomography scan analysis of screw tracts after percutaneous insertion of pedicle screws in the lumbar spine.
        Spine (Phila Pa 1976). 2000; 25: 615-621