Hybrid Kyphoplasty with Short-Segment versus Intermediate- and Long-Segment Pedicle Fixation for the Management of Thoracolumbar Burst Fractures

Abstract

Background Surgical treatment is usually recommended for thoracolumbar burst fractures (TLBFs) to mitigate the spinal deformity and/or neurological deficits. This study aimed to compare the clinical and radiographic outcomes of hybrid short-segment (HSS, four screws) technique with the traditional intermediate-segment (IS, six screws) and long-segment (LS, eight screws) pedicle screw fixations for treating acute TLBFs. Methods The patients in this study had acute single-level TLBFs with neurological deficits between levels T11 and L2, treated surgically between July 2013 and December 2019. We compared the surgical complications, blood loss, and operative duration of patients treated with the three pedicle screw techniques. We also compared postoperative thoracolumbar kyphotic degeneration between groups using the data on Cobb angles between the superior endplate of the vertebra above and inferior endplate of the vertebra below the fractured vertebra on lateral radiographic images at three time points (preoperatively, postoperative day 1, and postoperative follow-up). Forty-three patients were included: 15 treated with HSS, 12 with IS, and 16 with LS pedicle screw fixations. The end of follow-up (mean, 11.2 months) was defined as the most recent postoperative radiographic image or implant complication occurrence. Results We found significantly lower blood loss and shorter surgical durations in the HSS group than in the IS and LS groups. The HSS group exhibited the lowest rate of implant complications (13.33%), with the highest rate in the IS group (58.33%). Implant complications, including pedicle screw and rod dislodgement as well as pedicle screw damage and loosening, occurred at a mean follow-up of 7.5 (range: 6–9) months in the HSS group, 9 (range: 5–23) months in the IS group, and 7 (range: 1–21) months in the LS group. HSS patients demonstrated the most effective immediate kyphosis correction postoperatively. However, one patient underwent reoperation due to symptomatic cement leakage. Conclusions In the surgical treatment of single-level TLBFs, the HSS technique required a shorter operative duration and led to lower complication rates and operative blood loss than IS and LS approaches. This technique facilitates immediate kyphosis correction and successful maintenance of the corrected alignment 1 year later.