Late outcome of anterior versus posterior fixation for Thoraco-lumbar fractures

There is no clear study comparing the long-term outcome of either anterior or posterior fixation approaches for thoracolumbar fractures. To get a comparative analysis of the overall late outcome of both approaches, a total of 60 patients with unstable thoracolumbar fracture were classified into two groups; Group I (n=30) included those who were operated by posterior decompression and pedicle screw fixation, Group II (n=30) included patients who were operated by anterior neuro-decompression and fixation. After a mean of 4.9 years, patients were followed clinically according to Frankel Motor grading scale and Prolo economic / function outcome scale. Urodynamic studies and Sexual Health Inventory for Men (SHIM) scale were also undertaken. Patients underwent radiological evaluation of the sagittal alignment by measuring the kyphotic angle (KA) and regional kyphosis angle (RA). At final follow-up, significant neurological improvement was demonstrated in the anterior approach group. Functional outcome also showed statistically significant improvement (P<0.005) in anterior group with a 76.7% of patients showed excellent outcome; whereas excellent functional outcome was achieved in 50% only of posterior group. Both techniques resulted in statistically significant initial improvement in sagittal alignment (KA and RA), however, the posterior group lost this significance at follow-up whereas the anteriorgroup continued to demonstrate statistically significant improvement in sagittal alignment at follow-up P= 0.007. Restoring the anterior column stability to prevent future increased kyphotic deformity after obtaining initial correction has a long term significant correlation with the overall clinical and functional improvement.