Anterior vs. posterior fixation of burst fracture of thoracolumbar spine

The goals of surgical treatment of spinal injury are to achieve a pain-free and stable spinal column, and to help neurological recovery. Posterior fixation systems provide load-bypass around the burst vertebral body (VB); however, by bearing the major portion of the physiological load on the spinal column, the components connecting the fixation system to the spinal structures are prone to fail. At the same time, it is not possible to reduce the stress-shielding of the burst VB by employing more compliant and smaller posterior constructs, because even a small compressive load on the fractured VB causes substantial deformation, thereby predisposing the spine to kyphotic deformity, continuing impingement of the neural structures and associated pain. An anterior fixation procedure is presented, which employs a fixator implanted (by removing some burst posterior VB fragments) between the adjacent intact VBs. This anterior fixator is in series with the intact segment of the spinal column, and does not have connecting components. The fixator occupies about one-third of the burst VB, and is used in combination with an autogenous bone graft to also biologically connect the adjacent vertebrae and thereby reconstruct the fractured anterior spinal column.