Anterior decompression and fusion without instrumentation for burst fractures of the thoracic and lumbar spine

The usefulness and problems of anterior decompression and fusion without instrumentation for treatment of burst fractures of the thoracic and lumbar spine were studied by analyzing the surgical outcomes of 45 cases. According to the classification by Denis, the vertebral injury was type A in 12 cases, type B in 28 cases, type C in one case, type D in 2 cases and type E in 2 cases. According to the Frankel scale, neurological deficits in 22 cases were classified as C, in 13 as D, and in 10 as E. 31 cases had new injuries and 14 had old injuries sustained one month before surgery. Surgical outcome was determined with an average follow-up period of 3 years and 2 months. Neurological recovery and pain relief were achieved in 91% and 87% of the cases, respectively. Radiographic studies indicated that bony union was acquired in all of the cases. Kyphosis was corrected from 28.0°to 15.7°and correction loss was 4.0°at the time of final follow-up. The periods of postoperative bed rest and cast fixation were 3.9 and 5.2 weeks, respectively. Despite problems, including insufficient correction of kyphosis in old injury cases and prolonged postoperative care, anterior decompression and fusion without instrumentation provides sufficient neural decompression and solid fusion and is useful for the majority of patients with burst fractures.