Efficacy of anterior-posterior decompression on thoracolumbar spine fracture with spinal cord injury and analysis of risk factors for postoperative deep vein thrombosis

Abstract

Objective: To investigate the efficacy of anterior-posterior decompression on thoracolumbar spine fracture (TSF) and spinal cord injury (SCI), and assess hazard factors for postoperative deep vein thrombosis (DVT) through logistics regression.

Methods: A retrospective analysis was made on 130 patients with TSF and SCI admitted to our hospital between Jan 2018 and Jan 2020. Specifically, 72 were treated with anterior decompression (experimental group) and 58 were posterior decompression (control group). The intraoperative blood loss, procedure time, hospitalization, incision size, tactile and motor scores, injured vertebral body height, Cobb angle and complications were observed. Patients were grouped based on DVT occurrence. The risk factors were assessed through logistics regression.

Results: In comparison to experimental group, the intraoperative blood loss, procedure time and incision size in the control group were lower (P<0.05), while the hospitalization time was shorter (P<0.05). After treatment, the tactile and motor scores were improved 3 months after operation, and the experimental group was better (P<0.05). Additionally, injured vertebral body height and Cobb angle increased, and the experimental group was higher (P<0.05). Incidence of postoperative complications revealed no marked difference (P>0.05). Logistics regression analysis manifested that ASIA rating, diabetes, obesity and age were tied to postoperative DVT.

Conclusion: Anterior decompression therapy can effectively improve the clinical outcome of patients with thoracolumbar spinal fractures and spinal cord injury on the improvement of tactile and motor functions, but posterior decompression is better than anterior surgery in terms of bleeding, incision length, operating time, and hospital stay. Surgical treatment needs to be selected according to the condition of patients. Furthermore, it was identified that ASIA rating, history of diabetes, obesity and age are risk factors affecting patients with postoperative lower extremity DVT.

Keywords: Anterior-posterior decompression; deep vein thrombosis; risk factor analysis; spinal cord injury; thoracolumbar spine fracture.

Figure 1

Images of patients before and after treatment.

Figure 2

Value of ASIA rating, diabetes history, obesity and age in DVT. A. Predictive value of ASIA rating in DVT; B. Predictive value of diabetes history in DVT; C. Predictive value of obesity in DVT; D. Predictive value of Fat in DVT; Note: AUC: area under the curve.

Figure 3

ROC curve of DVT predicted by risk prediction equation. Note: AUC: area under the curve.