Objectives. Clinical trial to compare HR-P with anterior fixation technique in neurological outcome and preoperative parameters in the emergency treatment of unstable burst thoracolumbar fracture. Patients and methods. Twenty nine patients with burst fracture underwent either anterior neurodecompression and fixation (n=13) or posterior reposition and fixation with HR-P (n=16) depending on the type of implants available at the time of operation. Neurologically injured patients were operated within the first 8 hours and neurologically intact patients within the first 2 days after fracture. Neurological improvement was assessed according to the Frankel scale and the Prolo economic/ function outcome scale. We recorded operation time, blood loss, hospital stay and cost, complication and donor site pain. Results. There were no significant differences between the groups in either neurological improvement (p=0.789), economic and functional outcome (p=0.294, p=0.163), operative time was shorter in the HR-P posterior approach group than in the anterior group (median 172 min, range 145-220, vs. Median 255 min, range 200-295, p<0.001). Blood loss, hospital cost and complication rate was significantly lower in the posterior fixation group (p<0.001). Conclusion. Both surgical techniques were equally effective in neurological improvement. HR-P can be recommended in emergency neurodecompression and fixation of unstable lumbar and thoracolumbar fractures because of the shorter operation time and smaller blood loss
