Commentary of Acute and Hyperacute Thoracolumbar Corpectomy for Traumatic Burst Fractures Using a Mini-open Lateral Approach

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The authors have retrospectively reviewed their experience caring for individuals with acute thoracolumbar burst fractures, with varying degrees of neurological involvement, with a “mini-open” lateral approach allowing early decompression and stabilization. Their results are, certainly, encouraging.
There are some issues at hand, although I still believe their conclusions remain valid. One, it is a very small series of only 16 patients and the average follow-up is only 8.6 months. The authors also suggest that this approach has fewer complications and less morbidity than conventional thoracotomy or a thoracolumbar approach, and, that it obviates the need for an access surgeon. Their length of surgery, blood loss, complication rate, and average hospital stay in this study were really not significantly different from many other posterior, lateral, or anterior studies.
As well, I believe that the readers should cautiously interpret their results when reviewing their charge to determine the feasibility of acute (<24 hours postinjury) and even “hyper”-acute (<8 hours). The authors set out to compare but were unable to show a difference between the two, nor with other, more delayed approaches. With no control population, and little actual historical literature, I would suggest that the “safety” of surgery has as much to do with the patient's condition and traumatic comorbidities at the time of presentation, as any particular surgical technique. I do applaud the authors, and their associated health care providers, in the speed with which they were able to receive the injured patients and have them decompressed and stabilized.
Three of the 16 patients had injuries at T4, 7, and 8, respectively, which, technically, would be more of a thoracic spine injury than a thoracolumbar fracture which, by definition, at least, has been described as T10-L2.
Lastly, Figure 4 is of a 21-year-old with an L1 burst fracture and an incomplete neurological deficit. Figure 4A shows a clear laminar fracture. The recommended approach still remains posterior, first, to avoid trapping nerve roots with anterior expansion. And Figure 5 clearly is of a flexion-distraction fracture dislocation at T12-L1, with failure of both columns, and would thus, not be a true thoracolumbar burst fracture.
In summary, I believe that the “mini-open” lateral approach may well be another surgical option for those with acute thoracolumbar injuries requiring decompression and/or stabilization. Unfortunately, the authors were not able to ascertain whether this early surgical approach and technology improves the chances of neurological recovery.

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