Anterior and Anterolateral Approaches to the Lumbar Spine in a Developing Country: A Series of 28 Cases

Abstract

Background

The frequency of lumbar trauma in surgical emergencies at Niamey National Hospital, Niamey, Niger, is enormous. Injuries are most often amenable to an anterior or anterolateral approach, but because of a lack of expertise in surgical technique, they are usually operated on using a posterior approach. We aim to evaluate the management of lumbar spine fractures, including hinge fractures, using an anterior or anterolateral approach in a precarious context.

Methods

Retrospective and prospective observational descriptive study over 34 months including 28 patients who benefited from an anterior or anterolateral approach. The osteosynthesis material used was a bone graft fixed by a stainless steel plate and screws. The mean follow-up was 3 months.

Results

Anterior and anterolateral approaches had a hospital incidence of 3.16%. At follow-up, there was no neurologic deterioration, with an improvement in 75% of patients, despite deterioration of locoregional kyphosis in 76.92% of cases. One patient died in the immediate postoperative period and 1 died during medium-term follow-up.

Conclusions

The anterior approach to the spine is a therapeutic arsenal that needs to be mastered. Efforts are still required to acquire suitable equipment for correct sagittal balance.