An Advanced Study on Anterolateral Approach for Unstable Lumber Burst Fracture with Anterior Compression | Chapter 5 | Current Topics in Medicine and Medical Research Vol. 12

Context: Lumbar burst fractures are common spinal injuries that cause serious kyphotic deformity instability and neurological problems that involve surgical decompression and spinal instrumentation reconstruction for unstable burst fractures, although there is debate about the best anterior, posterior or combination approach to surgery. The retropulsion process of bone fragments from the broken endplates into the spinal canal is recognized by many to be the high energy transmitted during major trauma to the vertebral body, contributing to increased risks of neurological problems and kyphotic deformities.

Objectives: To test the effectiveness & protection of the anterolateral method in spinal instrumentation decompression and reconstruction for lumbar burst fractures. Subjects & Methods: A retrospective study involving 16 patients, 10 males and 6 females with lumbar burst fractures and anterior compression operationally treated with expandable cage or mesh cage filled with bone graft and screwed plate by anterolateral approach for corpectomy and single level fusion. After hospital discharge, the clinical and radiological follow-up ranged from 12 to 24 months.

Results: All patients improved by more than one grade after surgery with respect to the Frankel score, except that 2 Grade A cases did not improve. The mean preoperative visual analog scale was 7.4, which improved to 0.9 after surgery. After surgery, the mean local kyphosis increased from 8.8 ° before surgery to −1 °.

Conclusions: For unstable lumbar burst fractures, the anterolateral solution is a feasible, reliable, and secure approach. When the anterior solution is used, angular deformity is successfully corrected. An effective treatment modality is corpectomy with anterior approach and grafting. In addition to successfully correcting angular deformity through reconstruction of the anterior and middle columns with fusion, the anterior method also aims to enhance the neurological status of patients with neurological deficits by healthy and effective spinal canal decompression. Both of these are confirmed by our observations.

Author (s) Details

Wael Hammad
Neurosurgery Department, Armed Forces Hospitals, Southern Region, KSA.

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