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Currently, the treatment methods of lumbar burst fractures include anterior spinal approach, posterior spinal approach, and anterior combined with posterior approach. However, it is still controversial which the best approach is for lumbar burst fracture and what are their indications.


To assess clinical outcomes of surgical treatments through anterior, posterior approaches, and anterior combined with posterior approach for lumbar vertebrae burst fractures.


A total of 79 patients with lumbar burst fractures were treated by operation. Different approaches were selected according to conditions of injury: posterior approach (57 patients), anterior approach (12 patients), and anterior combined with posterior approach (10 patients). ASIA was used to assess the recovery of neurological function before and after treatment. Cobb angle, correction loss of Cobb angle, bone fusion rate, failure rate of internal fixation, operative time and intraoperative bleeding loss were observed before and after treatment.


All 79 patients were followed up for at least 19 months. Except no changes in the 5 complete paralysis cases, the ASIA classification of postoperative nerve function in 63 incomplete paralysis cases was improved by 1 grade or more. ASIA grade and the Cobb angle were obviously improved after operation, showing significant differences between preoperation and last follow-up (P < 0.05). The Cobb angle correction loss in patients with posterior approach was significantly larger than those with anterior approach and anterior combined with posterior approach (P < 0.05). Operative time and blood loss were significantly less in posterior approach compared with anterior approach and anterior combined with posterior approach (P < 0.05). Five cases with posterior approach suffered from screw breakage. There were no significant differences in the rate of bone fusion and postoperative neurological function recovery in three approaches (P > 0.05). Results suggested that the three surgical approaches can effectively treat lumbar burst fractures, and can achieve satisfactory clinical outcomes. Posterior approach easily affected fixation breakage and postoperative correlation loss. Anterior approach and anterior combined with posterior approach obtained less correlation loss. The surgeons should choose the surgical approach according to the characteristics of patients, and aim to achieve the best clinical outcomes.

Subject headings:

lumbar vertebrae; fractures, bone; internal fixators

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