The options of the three different surgical approaches for the treatment of Denis type A and B thoracolumbar burst fracture.

Thoracolumbar fracture is a common traumatic condition; however, the management remains challenging. The aim of this study is to establish criteria for selection of the anterior, posterior and posterolateral approaches for open reduction and internal fixation of thoracolumbar fracture. A group of 64 patients with Denis type A and B thoracolumbar burst fracture were treated with anterior, traditional posterior and paraspinal approach reduction with or without decompression. The fracture was fixed with titanium mesh and Z-plate by anterior approach and screw rod system by posterior approach and paraspinal approach. Clinical evaluations showed operation duration, blood loss, average length of incision and postoperative ODI in the paraspinal group were less than the traditional posterior group and anterior group. The statistical significant differences were reached (P < 0.05). There is not statistical difference between the three approaches for relevant parameters of radiographs (Cobb angle). The anterior approach surgery should be limitedly used for severe Denis type B fracture with direct reduction. The posterior approach is familiar to the spine surgeons and is commonly applied to most Denis type A and B thoracic lumbar fractures with indirect reduction and has less complication compared to the anterior approach, but also has some shortcomings. Paraspinal muscle approach is the muscle gap approach, in line with the minimally invasive surgery , which is now advocated with the idea with indirect reduction, compared to traditional surgery can significantly relieve postoperative pain and is worthy of further research and promotion.