Two-year follow-up evaluation of surgical treatment for thoracolumbar fracture-dislocation.

STUDY

DESIGN

A randomized, controlled clinical trial.

OBJECTIVE

This randomized controlled clinical trial was aimed at comparing the clinical outcomes of combined posteroanterior (P-A) fusion and transforaminal thoracic interbody fusion (TTIF) in cases of thoracolumbar fracture-dislocation.

SUMMARY OF BACKGROUND DATA: The optimal treatment strategy for thoracolumbar fracture-dislocation remains controversial.

METHODS

Sixty-one patients presenting with acute fracture-dislocation of the thoracolumbar joint between March 2010 and December 2011 were enrolled and randomly assigned to the P-A or TTIF group. The radiological outcome was assessed by acquiring radiographs in the standing position and computed tomographic scans. The clinical outcome was measured in terms of the American Spinal Injury Association score, visual analogue scale score, and Oswestry Disability Index. Moreover, we assessed the severity of overall morbidity and morbidity at the donor site in the 2 patient groups. The Student t and χ tests were used for the analysis of independent variables and categorical data, respectively.

RESULTS

Only 57 of the enrolled patients were available for the required 24-month follow-up period, 27 underwent TTIF and 30 underwent P-A fusion. Both treatments were similar with respect to the fusion rate, extent of decompression, loss of correction, rate of instrumentation failure, American Spinal Injury Association score, visual analogue scale score, and Oswestry Disability Index (P > 0.05). However, the blood loss, operating time, and rate of perioperative complications were greater in the P-A group than in the TTIF group (P < 0.05).

CONCLUSION

The clinical and radiological outcomes were similar for both the treatment procedures. However, our findings suggest that TTIF allows for safe interbody fusion and circumferential decompression, requires only a posterior approach, and is associated with a lower incidence of surgery-related complications.

LEVEL OF EVIDENCE: 2.