Treatment of Thoracolumbar Fracture with Anterior Approach

– 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 col-umn 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