Object:

Treatment strategy for thoraco-lumbar burst fractures is still debated. The aim of this study is to evaluate clinical and radiological outcomes of a two-stage strategy with immediate posterior percutaneous instrumentation and delayed antero-lateral fusion (Group A) versus a single stage open posterior instrumented fusion (Group B).

Patients and methods:

Demographics, clinical and surgical data of patients operated for AO Spine A3 and A4 fractures were prospectively collected. Vertebral height and deformity were evaluated prior and after surgery. VAS for back pain, ODI and SF-12 for quality of life assessment were collected during follow up.

Results:

Among the 110 patients enrolled, 66 were allocated to Group A and 44 to Group B; most common fractured level was T12 (34%). Postoperative complications resulted higher in Group B, especially wound infection rate (18% vs 3%), and pseudo-meningocele (14% vs 0%). The two-stage approach allowed an average long-term gain of 15.8° at the local kyphosis of fractured vertebra and 5.8° at the regional level (Cobb Angle), vs 15,4° and 5,5° of Group B. At 2-year follow-up, both Groups demonstrated significant functional improvements, however VAS and ODI metrics appeared more favorable for Group A patients (p<0.0001 vs p<0.003). Complete fusion rate was obtained in 100% of Group A vs 65% of Group B.

Conclusion:

Our study indicates that percutaneous instrumentation and anterior fusion or expandable cage lead to excellent long-term clinical and radiological outcomes with lower complication rate and higher fusion rate than open posterior approaches.