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ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 2  |  Page : 413-418

Evaluation of the short-term outcome of anterior approach surgery of the dorsal and lumbar spine


1 Department of Neurosurgery, Faculty of Medicine, Menoufia, Egypt
2 Department of General Surgery Department, Faculty of Medicine, Menoufia, Egypt

Correspondence Address:
Mohamed Nabil Hanafy
MSc, Neurosurgery Department, Menoufia Faculty of Medicine, Yaseen Abdelghaffar Street, Shebin El-Koum - 32511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.141717

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Objective The aim of this study is to evaluate the short-term outcome of anterior decompression and fusion surgery of the dorsal and lumbar spine, in cases of traumatic and pathologic vertebral fractures, in terms of stability and function. Background Surgical treatment of dorsal and lumbar spine fractures aims to achieve bony union and restore spinal anatomy. An anterior approach is recommended for repair of anterior bone loss and to release medullary compression. Materials and methods Selection criteria included traumatic and pathologic lesions causing vertebral body comminution, kyphotic angulation, or intractable pain. Exclusion criteria included patients with complete cord injury, osteoporosis, or less than 3 months life expectancy. Seven patients (group A) underwent the solo anterior approach surgery, whereas the other seven patients (group B) underwent initial posterior decompression and instrumented fusion, followed by anterior surgery. Operative and postoperative events were noted. Patients were followed up clinically and radiologically for 6 months. Results Seven patients showed improved ASIA grade postoperatively. The mean improvement in the ASIA grade was 0.6 in group A and 1.0 in group B. Seven patients regained bladder control, whereas two remained catheter dependent (one from each group). The pain visual analog scale range was 3-9 preoperatively and 0-5 postoperatively. The mean postoperative improvement in segmental kyphosis was 2.42° in group A and 1.85° in group B. After 6 months, 28.57% of patients in group A had grade-5 bone fusion, 42.86% had grade-4 fusion, 7.14% had grade-3, and 7.14% had grade-2 fusion, whereas 42.86% of patients in group B had grade-5 bone fusion and 57.14% had grade-4 fusion. No instability was detected in the dynamic radiographic films of all patients. Only one case had metallic device malposition because of trauma. Postoperative complications included chest infection (four cases), wound infection (two cases), urinary tract infection (one case), retroperitoneal hematoma (one case), and sympathetic dysfunction (one case). Conclusion The anterior approach for dorsal and lumbar fractures enables direct, under-vision satisfactory decompression of the neural tissue, facilitating improvement in the neurological functions of the patients. It also helps to correct the instability of the fractured vertebral column by both internal metallic fixation for temporary stability and bone grafting with a high percentage of bony fusion to achieve permanent stability.


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