J Korean Soc Spine Surg.  2001 Sep;8(3):419-422. 10.4184/jkss.2001.8.3.419.

Treatment of Thoracolumbar Fracture with Anterior Approach

• Park HJ
• Kim IG

• KMID: 2209765
• DOI: http://doi.org/10.4184/jkss.2001.8.3.419

Abstract

The anterior approach to the spine offers several unique solution to problems posed by patients with thoracolumbar injuries. The major weight-bearing elements of the spine are anterior and this is the area where injured elements impinging on the spinal cord can cause significant but reversible damage. The two primary areas of concern for surgeons treating these patients are restoration of mechanical stability of the spinal column and restoration or preservation of neurologic function. Indications for anterior decompression, 1)a large retropulsed fragment with significant (>50%) canal compromise, 2)anterior column comminution and marked kyphosis, and a time lapse of greater than 10 days from the time of injury. Anterior approaches are also recommended for the late treatment of symptomatic post-traumatic kyphosis that causes pain or neurologic deficit. The flexion-compression injuries addressed with anterior decompression and strut graft fusion require additional stability for satisfactory healing with maintenance of position assured during bone graft incorporation. Anterior instrumentation is most effective when balanced by an intact posterior ligamentous tension band. The anterior approach is more superior in canal clearance and effective in restoring bladder and bowel function.

Keyword

Thoracolumbar spine; Fracture; Anterior approach

MeSH Terms

Decompression
Humans
Kyphosis
Ligaments
Neurologic Manifestations
Spinal Cord
Spine
Transplants
Urinary Bladder
Weight-Bearing

Figure

• 

  Fig. 1-A. The retroperitoneal approach to the first lumbar vertebra from the left through an incision overlying the twelfth rib. Fig. 1-B. Orientation to the spinal canal is facilitated by tracing the course of the twelfth intercostal nerve. After removal of the left pedicle of the first lumbar vertebra, the retropulsed vertebral-body fragments of a burst fracture of the first lumbar vertebra are seen compressing the thecal sac. Fig. 1-C. The vertebral body fragments are removed with a high-speed burr until the base of the opposite pedicle is visualized. Fig. 1-D. An iliac-crest tricortical strut graft is locked in place using bone tamps. Each end is countersunk into the vertebral body above and below.

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