Advantages of Posterior Indirect Decompression Surgery in Thoracolumbar Burst Fractures with Neurologic Symptoms

Objective: Approximately 90% of spinal fractures occur at the thoracolumbar (T-L) junction and may be accompanied by neurological symptoms, in which decompression and post-fixation are generally performed. However, decompression surgery can aggravate patients’ symptoms due to adverse incidents, such as developing postoperative hematomas or iatrogenic spinal cord injury. This study compared the surgical and radiographic outcomes of patients with T-L junction burst fractures and neurological deficits who underwent direct or indirect decompression. Methods: We retrospectively reviewed all patients who had undergone posterior surgical treatment for T-L junction burst fractures with neurologic deficits. Patients were classified according to the procedure: indirect decompression (group 1) or spinal decompression through laminectomy and facetectomy (group 2). Clinical results and radiologic findings were compared between the two groups for 2 years. Results: Among 57 patients who met the inclusion criteria, 29 were categorized into group 1, and 28 were categorized into group 2. Group 1 had a statistically significantly lower Oswestry Disability Index score than group 2 at the final follow-up visit (p=0.03). In group 1, both the T-L junction angle and wedge angle of the injured vertebrae improved significantly, both immediately after surgery (p=0.02 and p=0.01, respectively) and at the final follow-up visit (p=0.01 and p=0.01, respectively). In group 2, the difference between the pelvic incidence and lumbar lordosis was significantly greater than in group 1 at the final follow-up visit (p=0.02). Conclusion: This study confirmed that symptoms could be sufficiently improved with indirect decompression, which should be kept in mind for cases where it is difficult to perform direct decompression,