Dilemma of Approaches to Thoracic and Lumbar Spine: Our 10 Years' Review

Abstract

Background Lesions of the thoracic and lumbar spine are numerous. These lesions affect one or more columns (anterior, middle, and posterior) of the spine and compress the spinal cord either from anterior or posterior, giving rise to the features of radiculomyelopathy. These lesions can be approached either from the anterior or posterior aspect of the spine. We present our past 10 years' experience regarding the comparison between the two approaches.

Methods Retrospective analysis of records of all patients with thoracic and lumbar lesion treated in our hospital between January 2005 and June 2014 was performed. Over the past 10 years, we came across 186 patients of thoracic and lumbar lesion who were operated either by anterior or posterior approach and were the focus of this study. Follow-up ranged from 6 months to 7 years.

Results All the patients presented with neurological deficits. They were evaluated with investigation protocol of our hospital. Anterior approach was done in 38 cases (n = 38), and posterior approach was done in 148 cases (n = 148). We compared between the two groups in terms of perioperative complications, recovery, persisting symptoms, and mortality.

Conclusion Complete recovery is better in the posterior approach (74.3 vs. 52.6%) and morality is more in the anterior approach (7.9 vs. 1.3%).

Keywords

columns - radiculomyelopathy - thoracic - lumbar

Publikationsverlauf

Eingereicht: 07. April 2015

Angenommen: 26. Juni 2015

Publikationsdatum:
16. Dezember 2015 (online)

• References

• 1 Royle ND. The operative removal of an accessory vertebra. Med J Aust 1928; 1: 467-468
• 2 Hodgson AR, Stock FE. Anterior spinal fusion a preliminary communication on the radical treatment of Pott's disease and Pott's paraplegia. Br J Surg 1956; 44 (185) 266-275
• 3 Humphries AW, Hawk WA. Anterior fusion of the lumbar spine using an internal fixative device. Surg Forum 1958; 9: 770-773
• 4 Dwyer AF, Newton NC, Sherwood AA. An anterior approach to scoliosis. A preliminary report. Clin Orthop Relat Res 1969; 62 (62) 192-202
• 5 Dwyer AF, Schafer MF. Anterior approach to scoliosis. Results of treatment in fifty-one cases. J Bone Joint Surg Br 1974; 56 (02) 218-224
• 6 Zielke K, Stunkat R, Beaujean F. Ventrale derotations-spondylodesis (author's transl) [in German]. Arch Orthop Unfallchir 1976; 85 (03) 257-277
• 7 Dunn HK. Anterior stabilization of thoracolumbar injuries. Clin Orthop Relat Res 1984; (189) 116-124
• 8 Dunn HK. Anterior spine stabilization and decompression for thoracolumbar injuries. Orthop Clin North Am 1986; 17 (01) 113-119
• 9 Garg B, Kandwal P, Nagaraja UB, Goswami A, Jayaswal A. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: a retrospective analysis. Indian J Orthop 2012; 46 (02) 165-170
• 10 Lin B, Chen ZW, Guo ZM, Liu H, Yi ZK. Anterior approach versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures: a prospective randomized controlled study. J Spinal Disord Tech 2011;
• 11 Chen ZW, Ding ZQ, Zhai WL. et al. Anterior vs. posterior approach in the treatment of chronic thoracolumbar fractures. Orthopedics 2012; 35: 219-224
• 12 Arts MP, Bartells RHMA. Anterior and posterior approach of thoracic disc herniation? A comparative cohort of mini-thoracotomy versus transpedicular discectomies. Spine J 2013; 14: 1654-1662
• 13 Aly T, Sayed ME, Ewais W. Surgical management of unstable thoracolumbar burst fractures: anterior versus posterior surgery. J Spine Neurosurg 2013;
• 14 Franic M, Tilzac MK, Pozar M. et al. Anterior vs. posterior approach in 3D correction of idiopathic thoracic scoliosis: a meta-analysis. J Pain 2012; 98: 795-802
• 15 Tuma M, Bagadatoglu H, Boyar B. et al. Anterior vs posterior instrumentation in the treatment of unstable thoracolumbar fractures: A retrospective analysis of 30 cases. Turk Neurosurg 1999; 9: 8-15
• 16 Philippe G, Marjorie S, Marc P. Isolated anterior approach or isolated post approach in the management of thoracolumbar spine fractures?. J Bone Joint Surg Br 2004; 86-B (Supp III): 296
• 17 Stancić MF, Gregorović E, Nozica E, Penezić L. Anterior decompression and fixation versus posterior reposition and semirigid fixation in the treatment of unstable burst thoracolumbar fracture: prospective clinical trial. Croat Med J 2001; 42 (01) 49-53
• 18 Xu GJ, Li ZJ, Ma JX, Zhang T, Fu X, Ma XL. Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis. Eur Spine J 2013; 22 (10) 2176-2183
• 19 Wu H, Wang CX, Gu CY. et al. Comparison of three different surgical approaches for treatment of thoracolumbar burst fracture. Chin J Traumatol 2013; 16 (01) 31-35
• 20 Freudenberger C, Lindley EM, Beard DW, Reckling WC, Williams A, Burger EL, Patel VV. Posterior versus anterior lumbar interbody fusion with anterior tension band plating: retrospective analysis. Orthopedics 2009; 32 (07) 492
• 21 Erickson MA, Kuklo TR, Emans JB, Puno RM, Mc Carthy RE. Prospective analysis comparing anterior vs. posterior approach for treatment of thoracolumbar idiopathic scoliosis. Spine 2009; 10: 53
• 22 Elasawaf A. Late outcome of anterior vs. posterior fixation for thoracolumbar fractures. Int Res J Basic Clin Stud 2013; 1 (02) 22-31
• 23 Muschik MT, Kimmich H, Demmel T. Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: results of 141 patients. Eur Spine J. 2006; Jul; 15 (07) 1128-1138