Multivariate analysis of risk factors for predicting supplementary posterior instrumentation after anterolateral decompr
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RESEARCH ARTICLE
Open Access
Multivariate analysis of risk factors for predicting supplementary posterior instrumentation after anterolateral decompression and instrumentation in treating thoracolumbar burst fractures Jiang Chen, Yu-Song Jia*, Qi Sun, Jin-Yu Li, Chen-Ying Zheng, Jian Du and Chun-Xiao Bai
Abstract Background: Although anterolateral decompression and instrumentation has several advantages in treating thoracolumbar burst fractures, the risk factors for supplementary posterior instrumentation are still unclear. Methods: We retrospectively reviewed 238 patients who underwent anterolateral decompression and instrumentation for single-level thoracolumbar burst fractures from January 2010 and March 2012. The influences of several potential risk factors that might affect supplementary posterior instrumentation were assessed using univariate and multivariate analyses. Results: Twenty seven patients who developed worsening back pain without neurological deterioration after the anterolateral approach treatment need further posterior instrumentation fixation. The univariate analysis showed that age, disruption of the posterior longitudinal ligament complex (PLC), and fracture level were the risk factors for supplementary posterior instrumentation. However, age and integrity of the PLC were the independent risk factors for supplementary posterior instrumentation by multivariate analyses. Conclusions: Supplemental posterior instrumentation was necessary in 11.3% of cases following anterolateral decompression and instrumentation in the present study. Older age and disruption of the PLC were the independent risk factors in prediction of supplementary posterior instrumentation in treating thoracolumbar burst fractures. Keywords: Thoracolumbar burst fracture, Anterolateral decompression, Posterior instrumentation, Multivariate analysis, Risk factors
Introduction About 20% of thoracic and lumbar fractures belong to thoracolumbar burst fractures [1,2]. This kind of fracture is frequently associated with neurologic deficits because of encroachment on the neural elements and at times owing to the dynamic nature of the injury. To some extent, management of thoracolumbar burst fractures is according to clinical and radiographic criteria [3-17]. The purpose of orthopedic surgery includes decompression of the neural elements, restoration of vertebral body height, correction of spinal deformity, * Correspondence: [email protected] Department of Orthopaedics, Dongzhimen Hospital, University of Chinese Medicine, Beijing 100700, China
and stabilization. Furthermore, surgery can be performed through a posterior approach [18-21] or through an anterolateral retroperitoneal flank approach [22-27], based on the necessity and extent of decompression. The anterolateral retroperitoneal flank approach allows the surgeon to conduct corpectomy and decompression of the canal. Bone fragments can be withdrawed from the canal under direct vision. After corpectomy, the vertebral column is reconstructed by inserting a prosthesis or graf
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