Analysis of safety and effect of reconstructing anterior and middle columns by single posterior approach in treating lumbar burst fractures.

OBJECTIVE To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures. METHODS From July 2005 to January 2007, 22 cases (18 males and 4 females, aged 28-57 years, 42.7 years on average) of lumbar burst fractures were treated with surgical procedures in our hospital. Based on the routine posterior approach, one of the transverse processes of the injured vertebra was incised to get access to the lateral side of the injured vetebral body. After all the displaced fracture fragments were cleared away and the spinal canal was decompressed, the titanium mesh packed with autografts was implanted from the lateral side to reconstruct the anterior and middle columns. The adjacent above and below segments of the vetebral body were fixed with transpedicular screws. The operation time, intraoperative blood loss, vertebral height, degree of kyphotic deformity and comprised spinal canal were documented. RESULTS The average operation time was 3.5 hours (ranging 2.8-5.8 hours) and the average blood loss was 820 ml (ranging 650-2 100 ml). All the cases were followed up for 17.2 months on average ( ranging 12-28 months). The height of the injured vetebral body was restored from 24 % (12%- 45%) preoperatively to 96% (95%-99%) postoperatively (P less than 0.05). The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury and 1 case was involved in the loosening of the connected rod of the pedicle screw system 3 months postoperatively. CONCLUSIONS The technique of implanting the titanium mesh by posterior approach is effective and safe enough to reconstruct the anterior and middle columns in treating lumbar burst fractures.