Surgical Planning for the Treatment of Thoracolumbar Fractures: Anterior, Posterior, or Combined Approach?

Burst fractures commonly occur at the thoracolumbar junction. After the decision has been made for surgical stabilization, the surgeon must select a surgical approach based on the patients' pathology, comorbidities, and surgical familiarity. The posterior approach is the most commonly used approach, as it is extensile, allows stabilization of multiple segments, allows deformity reduction maneuvers, and is most familiar to spinal surgeons. Anterior stabilization is appropriate for direct decompression of anterior compressive pathology, although it is less familiar to most spinal surgeons and often requires an approach surgeon. Combined anterior–posterior stabilization is the most rigid construct and may be most appropriate for incomplete neurological deficit at the cauda equina or conus medullaris level due to retropulsed anterior bone. This article will review the advantages and disadvantages of each approach to facilitate surgeon selection.