Evidence & Methods
Posterior decompression, vertebral augmentation, and pedicle screw instrumentation is being used more frequently for osteoporotic burst fractures. The authors compare their outcomes with the more traditional anterior corpectomy approaches.
In this retrospective cohort of consecutive cases, the authors found that blood loss, need for revision surgery, and respiratory complications were higher in the anterior group while outcomes were otherwise comparable between groups.
While ideally an RCT or well-matched cohort study would have better answered this question, the findings are commensurate with many surgeons’ experiences. Taking down the diaphragm and obtaining good fixation anteriorly can be difficult in this population and associated with complications. Alternatively, decompression and anterior column support can often be obtained adequately with vertebroplasty or kyphoplasty through an all-posterior approach. The publication of additional series with similar results may make equipoise difficult for higher level investigation.