Abstract
Background Short-segment transpedicular screw fixation (SSTSF) is the preferred treatment option for thoracolumbar burst fractures. Adding screws in the fractured body may be helpful in achieving and maintaining fracture reduction. However, the operative approach is disputed. Objective To compare clinical outcomes of transpedicular fixation with and without screws in the fractured vertebral body after isolated uncomplicated fractures at the thoracolumbar junction. Material and methods A retrospective cohort study enrolled 62 patients with Th11–L2 thoracolumbar burst fractures (AOSpine A3, A4) who underwent SSTSF with (n = 32) and without (n = 30) pedicle screws at the fracture level. Demographic data of the patients, operating time and blood loss were registered. Clinical evaluation using Visual analogue scale (VAS ) for pain, Oswestry Disability Index (ODI) to quantify disability and imaging parameters of segmental kyphosis, loss of correction, anterior vertebral body height (AVBH) at the fracture level, spinal canal stenosis (SCS) were measured preoperatively, at one week, 1 month, 6 and 12 months postoperatively. Results The patients of the two groups showed no statistically significant differences in the demographic data, VAS and ODI scores, measurements of kyphotic angle, AVBH, SCS preoperatively (p > 0.05). Screws at the fracture level did not affect the operating time and intraoperative blood loss relative to conventional no-screw group. Benefits with fracture screws were evident at 7 days (p < 0.01) measuring SCS, at 6 months (p < 0.01) and 12 (p < 0.01) months measuring kyphotic angle. There was better kyphosis correction (p < 0.01) and AVBH (p = 0.034) seen at 12 months after surgery. Conclusion Reinforcement of a broken vertebra with fracture-level screws has been shown to provide better stability of clinical and radiographic results as compared to those with conventional SSTSF.
Highlights
Fractures of the thoracolumbar junction (T11–L2), the transition from the less mobile thoracic spine to the more dynamic lumbar spine, are the most common fractures of the spinal column
Mean intraoperative blood loss was comparable in both groups measuring 150 mL
The technique is superior to conventional Short-segment transpedicular screw fixation (SSTSF) in stability due to the greater number of supporting components and additional reinforcement provided for the anterior spinal column avoiding negative effect on the spinal biomechanics relative to polysegmental fixation
Summary
Fractures of the thoracolumbar junction (T11–L2), the transition from the less mobile thoracic spine to the more dynamic lumbar spine, are the most common fractures of the spinal column. Thoracolumbar burst fractures (AOSpine A3, A4) are normally stabilized with surgical techniques. Common surgical goals are to obtain the most stable fixation, correct the deformity and prevent the recurrence, produce spinal decompression to allow early ambulation. Shortsegment transpedicular screw fixation (SSTSF) is the preferred treatment option for thoracolumbar burst fractures for stabilizing the three-column spine. Polysegmental fixation, circular stabilization of the spine and procedures performed using the anterior approach are alternatives to the conventional transpedicular screw fixation. Short-segment instrumentation can be augmented with additional pedicle screws placed at the fracture level. The intermediate screws inside the fractured vertebra can improve stability of the anterior column due to additional reinforcement and reduce stress on each pedicle screw. Short-segment transpedicular screw fixation (SSTSF) is the preferred treatment option for thoracolumbar burst fractures.
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