Stand-alone anterolateral retro-peritoneal approach for traumatic lumbar burst fracture

Abstract

Background: Burst lumber spine fractures are very common serious injuries. They make severe instability, disability, kyphotic deformities and affect patient quality of life. Present of intra canal bony fragments that cause neurological affection requiring surgical decompression and reconstruction. There are different surgical modalities to manage traumatic lumber burst fractures anterior, post or combined approaches. The optimal treatment remains controversial. Methods: We conducted prospective study that include 20 adult cases with traumatic lumber burst spine fractures subjected to anterior-only decompression and stabilization through retro-peritoneal approach by single level fusion by mesh cage loaded with bone graft in the department of Neurosurgery, Tanta University Hospitals between July 2022 and July 2023. Results: Anterior-only decompression and stabilization was done to 20 cases, 12(60%) patients were male and 8(40%) patients were female. Oswestry Disability Index (ODI) ranged from 80-90 with a mean 85.6±4.03 before surgery and 21-50 after surgery with a mean 36.±12.82. The pain was evaluated using an 11-point Visual Analog Scale for Pain (VAS Pain) Scale. It was ranged from 7-9 pre-operatively with a mean value of 8.2±1.8 and from 1-3 post-operatively with a mean value of 2.3±1.6. 75% of neurological affected patients improved at least one grade according frank classification scale of neurological affection after surgery. Sagittal alignment, kyphotic angle and fusion was restored and maintained in 96% of patient Conclusion: Anterior lateral retroperitoneal stand-alone technique in management of traumatic lumber burst fracture shows promising outcome and many advantage. It allows direct anterior decompression of neural element, removal of bony fragment, short segment fixation, preservation of intact posterior column, improvement in segmental angulation and acceptable rate of arthrodesis.