Short Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled Trial

Abstract

Background Data: Selection of stabilization procedures for treating thoracolumbar burst fractures remains controversial. Both long-segment and short-segment pedicle screw fixation including the fractured vertebral body have been used widely with no consensus on the better method. Purpose: To compare between the long segment and short-segment with intermediate screw (s) fixation of thoracolumbar junction burst fractures in terms of radiological and clinical outcomes. Study Design: Prospective randomized controlled trial. Patients and Methods: Fifty consecutive patients (32 males and 18 females, mean age 33.6±14.6 years) with thoracolumbar burst fractures presenting during the period between October 2015 and December 2016 to Assiut University hospital were randomized into one of two groups. Group A (25 patients) was treated by long segment pedicle screw fixation, i.e., fixation of 2 levels above and below the fractured vertebra. Group B (25 patients) was treated by short segment fixation, i.e., 1 level above and 1 level below the fractured vertebra, with one or 2 intermediate screws in the fractured vertebra itself. The study protocol was approved by our institution review board and all patients signed an informed consent. The inclusion criteria were single level Type A3 and A4 fracture at thoracolumbar junction, regardless of their neurological status. All patients were treated within 48 hours from the injury. Monoaxial screws were used in all patients. Assessment of kyphosis correction by using the Cobb method and restoration of the anterior vertebral body height was performed radiologically postoperatively and at 3 and 6 months follow up. The clinical outcomes were evaluated using the modified Macnab criteria in the last follow-up. Radiological and clinical assessment was made by an independent observer. Results: Demographic data of both groups were quite comparable. The mean operative time in Group B was significantly shorter than in group A (85±28 min. and 110±0.59 min. respectively). The mean operative blood loss was also significantly lower in Group B than in Group A (476±133.2cc and 656±195.9cc respectively). There was no significant difference between both groups as regards the degree of local kyphosis angle correction and anterior vertebral body height restoration or the correction loss observed during the follow up. Neurological recovery was observed in all patients. Clinically, 14 (56%) patients 7

Could Intermediate Screw in Thoracolumbar Fracture Fixation Save Motion Levels? Comparative Study between Long-Segment and Short-Segment with Intermediate Screw Fixation

“…This was not the case in our study where the loss of kyphotic correction was insignificant between the early postoperative The EGYPTIAN SPINE Journal and final follow-up. This may be due to the use of the monoaxial screws in our study like the study of El-Sharkawi et al 4 that used also monoaxial screws in the fixation of the vertebra and reported few degrees of correction loss in both long-and shortsegment groups between the initial correction and final follow-up and it was statistically insignificant.…”

“…Other studies 4,5 stated that the use of screws in the fractured vertebra with short-segment fixation provides correction of kyphosis comparable to long-segment fixation. The loss of correction in one of these studies 5 was correlated to the amount of initial angle correction in the early postoperative and it did not exceed 7 • loss in the last follow-up in the short-segment fixation.…”

Short segment versus long segment pedicle screws fixation in management of thoracolumbar burst fractures

“…In unstable thoracolumbar burst fractures, operative stabilization is preferred. The main goals of surgery are restoration of spinal stability, correction of deformity, and decompression of the spinal canal with the preservation of neurologic function [5,6].…”