Anterior versus posterior surgical treatment of unstable thoracolumbar burst fracture

Objective This retrospective study compares clinical outcomes of anterior versus posterior surgery for treatment of unstable thoracolumbar fracture. Methods Retrospective analyses of 96 patientswith unstable thoracolumbar fracture of one vertebral body (T11–L2) treated by surgery. Fifty-one patients had anterior surgery (AG), and 45 had posterior surgery (PG). Neurological function outcome was evaluated by American Spinal Injury Association (ASIA) classification, and Short Form-36 (SF-36) health survey was used to evaluate both physical andmental status of patients. Sagittal and coronal Cobb angle, canal compromise, and fusion rate were evaluated on radiographic film. Results There were no intraoperative deaths, and no patient experienced neurological deterioration. After surgery, neurological function as measured by Frankel grade improved on average 0.961 in AG and 0.956 in PG. Clearance rate of encroachment and canal compromise at final follow-up were significantly better in AG than in PG (P\0.001). At long-term follow-up, loss of sagittal correction was more severe in PG than in AG (P\0.01). However, coronal plane deformity correction was better in PG than in AG (P\0.001). SF-36 physical functioning (PF), role limitations due to physical health (RP), and social functioning (SF) scale values were higher in AG than in PG (P\0.001), and role limitations due to emotional problems (RE) scale value was higher in PG than in AG (P\0.05). There were no complications and no metal failure in AG, and two complications of PG with pseudarthroses were identified on radiographic analyses (one case of screw breakage and one case of screw loosened). Conclusions Anterior and posterior surgery are reliable procedures with good outcome in unstable thoracolumbar fracture. Anterior surgery showed superior results regarding postoperative canal compromise, loss of sagittal alignment, and complications, but posterior surgery had shorter surgery time, less blood loss, and shorter hospital stay, and ultimately no difference in neurological improvement.