Outcomes Following Anterior vs. Posterior Surgical Interventions for Burst Fractures: A Propensity-Matched National Database Study

Introduction: Burst fractures are common traumatic spinal injuries requiring surgical intervention to alleviate neural compression and stabilize the spine. The optimal approach to minimize hospital-associated complications remains unclear. This study aims to analyze in-hospital complications following anterior and posterior surgical approaches in patients with traumatic vertebral burst fractures.

Methods: The National Trauma Data Bank was queried from 2017 to 2019 for all patients with traumatic thoracolumbar burst fractures managed with a subsequent anterior or posterior approach spinal fusion surgery, excluding patients managed with a combined approach. Paired Student’s t-tests and Pearson’s Chi-squared analyses were used to compare differences between the groups. Patients were then matched based on demographics and injury severity using the k-nearest neighbors algorithm for propensity score matching. Alpha was set to 0.05.

Results: Among the 7,347 patients meeting the inclusion criteria, 474 underwent anterior approach fusion, while 6,873 underwent posterior approach fusion. Demographics did not significantly differ between the two groups, except for varying rates of hypertension and total Glasgow Coma Scale (GCS), both of which were lower in the anterior group (p < 0.05). Patients who received a posterior approach fusion exhibited significantly lower rates of catheter-associated urinary tract infections and pulmonary embolisms (p < 0.05 for all). Additionally, they experienced a shorter hospital stay (p=0.027). After one-to-one matching, patients undergoing posterior approach fusion had lower rates of unplanned intensive care unit (ICU) admissions (p=0.047). While not statistically significant, the posterior approach showed a trend towards lower rates of in-hospital complications.

Conclusion : This retrospective analysis revealed no significant differences in outcomes between patients undergoing anterior and posterior approach fusion for burst fractures. Notably, the posterior approach demonstrated a modest clinical advantage with a shorter length of hospital stay. Further research is warranted to elucidate the long-term implications of these divergent surgical approaches.