Radiologic Outcomes after Operative Management of Traumatic Spine Fractures: Stand-Alone Posterior Stabilization Versus Combined Anteroposterior Approach

Objective. Previous research emphasises correcting deformities resulting from spine fractures by restoring sagittal alignment and vertebral height. This study aims to compare radiological outcomes, including sagittal index (SI) and loss of vertebral body height (LVBH), between stand-alone posterior stabilisation (Group I) and the posteroanterior/combined approach (Group II) in the operative management of traumatic thoracic or lumbar spine fractures. Methods. In this retrospective single-centre study, all patients with traumatic spine fractures (T1 to L5) undergoing surgical stabilisation between January 1, 2015, and May 31, 2021, were included. Two spine surgeons independently assessed imaging, recording SI and LVBH values at baseline, after each surgical intervention, and during follow-up (at least three months post-treatment). The mean values of SI and LVBH between the assessing surgeons were utilised. Linear mixed-effects regression models, adjusted to baseline values, compared SI and LVBH between the two groups. Results. 71 patients (42 men), median age 38 years (IQR 28 to 54), with a median follow-up of 4 months (IQR 3 to 17), were included. 32 were in Group I and 39 in Group II. 40 fractures included the thoracolumbar junction (T12 or L1), 15 affected the thoracic- and 14 the lumbar spine. The regression model revealed superior sagittal alignment in Group II, with an adjusted mean difference for SI of -4.24 (95% CI -7.13 to -1.36; p-value=0.004), and enhanced restoration of vertebral body height with an adjusted mean difference for LVBH of 0.11 in the combined approach (95% CI 0.02 to 0.20; p-value=0.02). Nine postoperative complications occurred in the entire cohort (4 in Group I and 5 in Group II). Conclusions. Combined posteroanterior stabilisation for spine fractures improves deformities by enhancing sagittal alignment and increasing vertebral body height, with acceptable morbidity compared to the stand-alone posterior approach.