Thoracolumbar burst fracture with complete paraplegia: rationale for second-stage anterior decompression and fusion regarding functional outcome

BACKGROUND: Appropriate management of thoracolumbar injury with complete paraplegia remains controversial. Purpose of present study is to study whether advantages are worth the morbidity associated with staged anterior decompression in these patients. MATERIALS AND METHODS: Forty patients (90% male) with fracture of T12 (32 cases) and L1 (8 cases) with complete paraplegia underwent transpedicular fixation. Average age of patients was 42 years (range 13–57 years). Most common fracture pattern was type A3.1 (55%). Rational staged anterior decompression was done in 20 cases. One group received transpedicular fixation (n = 20) and another fixation and staged decompression (n = 20). Average follow-up was 2.5 years. RESULTS: Mean functional independence measurement (FIM) score was 98 in fixation group and 112 in decompression group; mean neurological recovery as measured by American Spinal Injury Association (ASIA) grade was 1.3 and 1.75, respectively. Incidence of postoperative complications was 20% and 60%, respectively. Sphincter control did not recover in either group. CONCLUSIONS: Rehabilitation is better after staged anterior decompression and fusion in burst fracture of thoracolumbar junction with complete paraplegia.