In general, all surgical stabilizations for thoracolumbar spine fractures should start posteriorly.
In some cases a posterior reduction and stabilization procedure is followed by an anterior decompression and fusion when a) additional anterior column support is required or b) additional anterior decompression is indicated.
The anterior stabilization is a useful method to relieve pressure on the compromised neurological elements or to provide anterior column support. This is particularly indicated:
If anterior spinal cord compression persists
If residual instability persists
If initial loss of correction occurs
If the vertebral body is significantly destroyed and a secondary loss of correction might be anticipated
If the disc is destroyed.
The anterior stabilization can be used as a stand-alone method.
The anterior approach should be followed by a posterior reconstructive procedure to provide further stabilization in the setting of posterior ligamentous disruption or poor bone quality (osteopenia).
Keep in mind that during additional anterior stabilization the reduction is normally limited by the posterior screw/rod system in place.