Combined Anterior-Posterior Surgery Versus Posterior Surgery for Thoracolumbar Burst Fractures: A Systematic Review of the Literature

Pim P. Oprel*, Wim E Tuinebreijer, Peter Patka, Dennis den Hartog
Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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© Oprel et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Surgery- Traumatology, Erasmus MC, University Medical Center Rotterdam, ‘s- Gravendijkwal 230, Office H-815, 3015 CE Rotterdam, The Netherlands; Tel: +31 10 7032395; Fax +31 10 7032396; E-mail:


Study Design:

A systematic quantitative review of the literature.


To compare combined anterior-posterior surgery versus posterior surgery for thoracolumbar fractures in order to identify better treatments.

Summary of Background Data:

Axial load of the anterior and middle column of the spine can lead to a burst fracture in the vertebral body. The management of thoracolumbar burst fractures remains controversial. The goals of operative treatment are fracture reduction, fixation and decompressing the neural canal. For this, different operative methods are developed, for instance, the posterior and the combined anterior-posterior approach. Recent systematic qualitative reviews comparing these methods are lacking.


We conducted an electronic search of MEDLINE, EMBASE, LILACS and the Cochrane Central Register for Controlled Trials.


Five observational comparative studies and no randomized clinical trials comparing the combined anteriorposterior approach with the posterior approach were retrieved. The total enrollment of patients in these studies was 755 patients. The results were expressed as relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes with 95% confidence intervals (CI).


A small significantly higher kyphotic correction and improvement of vertebral height (sagittal index) observed for the combined anterior-posterior group is cancelled out by more blood loss, longer operation time, longer hospital stay, higher costs and a possible higher intra- and postoperative complication rate requiring re-operation and the possibility of a worsened Hannover spine score. The surgeons’ choices regarding the operative approach are biased: worse cases tended to undergo the combined anterior-posterior approach.

Keywords: Systematic review, outcome, burst fracture, thoracolumbar spine, technique, surgery.