Posterior Fixation of Thoracolumbar Burst Fracture

Nov 25, 2005Journal of spinal disorders & techniques

Backbone fracture surgery: comparing short versus long segment stabilization

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Abstract

The short-segment group experienced a 55% failure rate compared to the long-segment group.

Measurements of local kyphosis, sagittal index, and anterior vertebral height compression indicated better outcomes for the long-segment group.
The long-segment instrumentation required longer operative times and resulted in increased blood loss.
Despite differences in radiographic outcomes, both groups showed no significant variation in clinical outcomes as measured by the Low Back Outcome Score.
Findings suggest that anterior column support could potentially reduce the need for long-segment fixation.
The short-segment fixation might have yielded better results with the use of two pedicle screws above and below the fractured vertebra.

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OBJECTIVE: The treatment of thoracolumbar burst fracture is a controversial issue. Short-segment (SS) pedicle fixation has become a popular treatment option. However, there are several studies regarding the high rate of failure. The aim of this prospective study was to compare SS versus long-segment (LS) instrumentation.

METHODS: For this purpose, 18 consecutive patients were assigned to two groups. Group 1 included nine patients treated by SS pedicle fixation, whereas group 2 included nine patients treated by LS instrumentation. SS instrumentation was pedicle fixation one level above and below the fractured vertebra. LS instrumentation was hook fixation (claw hooks attached to second upper vertebra and infralaminar hooks attached to first upper vertebra) above and pedicle fixation (pedicle screws attached to first and second lower vertebrae) below the fractured vertebra.

RESULTS: As a result, measurements of local kyphosis, sagittal index, and anterior vertebral height compression showed that the LS group had a better outcome at final follow-up (P < 0.05). Also, the SS group had a 55% failure rate, whereas the LS group had prolonged operative time and increased blood loss. However, there was no difference between the two groups according to Low Back Outcome Score.

CONCLUSIONS: In conclusion, radiographic parameters demonstrated that LS instrumentation is a more effective management of thoracolumbar burst fractures. Nevertheless, clinical outcome was the same between the two groups. However, our conclusions were based on posterior-only surgery. Anterior column support would negate the need for LS fixation. Also, SS would have been more successful if two above and two below pedicle screws were used.

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Posterior Fixation of Thoracolumbar Burst Fracture

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