Anterior column reconstruction with mono-segmental fusion and lag screw fixation of sagittal split for burst-split fracture of the thoracolumbar spine.

This study retrospectively reviews 20 sequential patients with thoracolumbar burst fractures without neurologic deficit. All patients were treated by indirect reduction, bisegmental posterior transpedicular instrumentation and monosegmental fusion. Clinical and radiological outcome was analyzed after an average follow-up of 6.4 years. Re-kyphosis of the entire segment including the cephaled disc was significant with loss of the entire postoperative correction over time. This did not influence the generally benign clinical outcome. Compared to its normal height the fused cephalad disc was reduced by 70% and the temporarily spanned caudal disc by 40%. Motion at the temporarily spanned segment could be detected in 11 patients at follow-up, with no relation to the clinical result. Posterior instrumentation of thoracolumbar burst fractures can initially reduce the segmental kyphosis completely. The loss of correction within the fractured vertebral body is small. However, disc space collapse leads to eventual complete loss of segmental reduction. Therefore, posterolateral fusion alone does not prevent disc space collapse. Nevertheless, clinical long-term results are favorable. However, if disc space collapse has to prevented, an interbody disc clearance and fusion is recommended.

Retrospective study. Short-segment pedicle instrumentation (SSPI) is widely used to treat thoracolumbar junction fracture. Implant failure is the most common complication of SSPI and often necessitates revision surgery. The stand-alone anterior technique for failed SSPI provides excellent decompression and anterior column reconstruction, but it is incapable of restoring normal stability. High rate of complications is solely attributable to the anterior approach. Thus, the reconstruction of the anterior column with posterior compression instrumentation is the strategy of choice. In this study, we use a modified pedicle subtraction osteotomy (PSO) technique through a single posterior approach as the salvage method for the failed SSPI. Thirteen patients with failed SSPI after thoracolumbar fracture were included and followed up at regular intervals. Revision indications include intractable pain, deteriorating neurological deficits, and progressive deformity. The modified PSO was performed. After osteotomy, the anterior cortex was thinned and the anterior longitudinal ligament was also preserved to maintain stability during correction. Autograft was inserted into the osteotomy gap to increase stability and fusion rate. The correction had been achieved with closure. We evaluated the patients' clinical symptoms, segmental kyphosis correction, bony fusion time, and complications. Segmental kyphosis correction was from preoperative average 20.9 degrees (range, 9.5-38.5 degrees) to 3.0 degrees (range, 1-5.5 degrees) immediately after operation and 6.1 degrees (range, 3-8 degrees at the last follow-up). Bony fusion was confirmed on radiographs in all patients at an average of 9.9 months (range, 7.5-12 mo) after revision surgery. There was no implant failure in any of the 13 patients. Average preoperative visual analog scale was 6.5 (range, 5-9) and reduced to 3.7 (range, 2-5) at the last follow-up. There was also a significant decrease in mean preoperative Oswestry Disability Index from 55.2 (range, 38-76) to 32.8 (range, 16-56). No patients suffered any neurological deterioration related to revision surgery. Complications were encountered in 6 patients (46.1%), including 4 with cerebrospinal fluid leak and 2 with superficial wound infection. All these complications were managed conservatively and none of them underwent reoperation. We conclude that modified PSO possesses the advantages of excellent kyphosis correction, a safe and reliable salvage alternative for the revision of SSPI failure.

The surgical management of thoracolumbar fractures presents potential benefits. However, the surgery solve the instability by fusion of mobile segments. We incorporate in our treatment algorithms, the use of restricted arthrodesis at injured levels, regardless of longer instrumentations, as well as the use of non-fused transitory stabilizations, based on the conviction that in non-fused segments without traumatic disc injury, mobility persists once the instrumentation is removed. The goals of this study were to compare the mobility of non-fused segments after hardware removal to a normal range of motion and to find prognostic pre-op imaging patterns. We reviewed 21 consecutive patients who underwent surgery with preservation of mobile segments (non-fused segments included in the construction) in order to recover mobility after removal of instrumentation, performed between 1995 and 2001. All patients were treated by indirect reduction with posterior transpedicular instrumentation. Clinical and radiological outcome was analyzed after an average follow-up of 46.6 months. Satisfactory subjective outcome results were obtained in 94.7%. The dynamic radiological follow-up study showed 75% (21 segments) with normal or decreased range of motion (ROM) and 25% (7 segments) without mobility. The non-fused segments with hardware removal before 10 months of evolution presented a normal or decreased mobility in 83.2% while the segments with hardware removal after 10 months showed 68.8% of mobility. The intervertebral disc (IVD)'s with normal initial MRI morphology preserved their mobility in 81.9%. Complications occurred in four patients: two superficial wound infections and two patients presented a late fracture of one USS Schanz. The results of this study prove that in thoracolumbar fractures, non-fused spinal segments included in pedicular instrumentation maintained mobility in a high percentage once the hardware is removed. 75% of the segments presented a normal or decreased ROM.

To investigate if bone substitutes are strictly necessary to restore the vertebral body height and improve the clinical outcome, in patients with thoracolumbar or lumbar AO type A post-traumatic vertebral fractures, managed with balloon kyphoplasty combined with posterior screw and rod system. 105 patients with post-traumatic thoracolumbar spine fracture were recruited. At baseline, the patients underwent a CT and an MRI of the spine. Clinical evaluation was performed, using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), at baseline, 48h after surgery, at 3-month follow-up (FU), 6-month FU, 48h after the instrumentation removal and at 24-month FU. At each FU, VK, regional kyphosis (RK), central wall (MH/PH) and anterior wall (AH/PH) heights were assessed on lateral spine X-rays. At 6-month FU, a CT scan of the spine was performed to investigate the fracture healing. The posterior instrumentation was removed 7months after surgery (range 6-10months). A significant reduction of mean VAS (p < 0.05) and ODI (p < 0.05) was observed after surgery; no impairment of these scores was observed after the instrumentation removal. A significant correction of VK, RK, AH/PH and MH/PH was recorded after surgery; no significant changes of these values were noticed at subsequent FU. After the instrumentation removal, only an RK impairment was recorded, but it was not significant. PMMA or bone substitutes are not necessary to keep the reduction of the endplate obtained with the balloon tamp, when BK is performed in the association with posterior percutaneous pedicle screws instrumentation. These slides can be retrieved under Electronic Supplementary Material.

The treatment of unstable thoracolumbar burst fractures with short-segment posterior spinal instrumentation without anterior column reconstruction is associated with a high rate of screw breakage and progressive loss of reduction. The purpose of the present study was to evaluate the functional, neurologic, and radiographic results following transpedicular, balloon-assisted fracture reduction with anterior column reconstruction with use of calcium phosphate bone cement combined with short-segment posterior instrumentation and a laminectomy.A consecutive series of thirty-eight patients with an unstable thoracolumbar burst fracture with or without neurologic deficit were managed with transpedicular, balloon-assisted fracture reduction, calcium phosphate bone cement reconstruction, and short-segment spinal instrumentation from 2002 to 2005. Twenty-eight of the thirty-eight patients were followed for a minimum of two years. Demographic data, neurologic function, segmental kyphosis, the fracture severity score, canal compromise, the Short Form-36 score, the Oswestry Disability Index score, and treatment-related complications were evaluated prospectively.All thirteen patients with incomplete neurologic deficits had improvement by at least one Frankel grade. The mean kyphotic angulation improved from 17 degrees preoperatively to 7 degrees at the time of the latest follow-up, and the loss of vertebral body height improved from a mean of 42% preoperatively to 14% at the time of the latest follow-up. Screw breakage occurred in two patients, and pseudarthrosis occurred in one patient.The present study demonstrates that excellent reduction of unstable thoracolumbar burst fractures with and without associated neurologic deficits can be maintained with use of short-segment instrumentation and a transpedicular balloon-assisted reduction combined with anterior column reconstruction with calcium phosphate bone cement performed through a single posterior incision. The resultant circumferential stabilization combined with a decompressive laminectomy led to maintained or improved neurologic function in all patients with neurologic deficits, with a low rate of instrumentation failure and loss of correction.

The treatment of unstable thoracolumbar burst fractures with short-segment posterior spinal instrumentation without anterior column reconstruction is associated with a high rate of screw breakage and progressive loss of reduction. The purpose of the present study was to evaluate the functional, neurologic, and radiographic results following transpedicular, balloon-assisted fracture reduction with anterior column reconstruction with use of calcium phosphate bone cement combined with short-segment posterior instrumentation and a laminectomy. A consecutive series of thirty-eight patients with an unstable thoracolumbar burst fracture with or without neurologic deficit were managed with transpedicular, balloon-assisted fracture reduction, calcium phosphate bone cement reconstruction, and short-segment spinal instrumentation from 2002 to 2005. Twenty-eight of the thirty-eight patients were followed for a minimum of two years. Demographic data, neurologic function, segmental kyphosis, the fracture severity score, canal compromise, the Short Form-36 score, the Oswestry Disability Index score, and treatment-related complications were evaluated prospectively. All thirteen patients with incomplete neurologic deficits had improvement by at least one Frankel grade. The mean kyphotic angulation improved from 17 degrees preoperatively to 7 degrees at the time of the latest follow-up, and the loss of vertebral body height improved from a mean of 42% preoperatively to 14% at the time of the latest follow-up. Screw breakage occurred in two patients, and pseudarthrosis occurred in one patient. The present study demonstrates that excellent reduction of unstable thoracolumbar burst fractures with and without associated neurologic deficits can be maintained with use of short-segment instrumentation and a transpedicular balloon-assisted reduction combined with anterior column reconstruction with calcium phosphate bone cement performed through a single posterior incision. The resultant circumferential stabilization combined with a decompressive laminectomy led to maintained or improved neurologic function in all patients with neurologic deficits, with a low rate of instrumentation failure and loss of correction.

Thoracolumbar burst fractures treated with short-segment posterior instrumentation without anterior column support is associated with a high incidence of implant failure and correction loss. This study was designed to evaluate the clinical and radiographic results following posterior short-segment instrumentation and limited segmental decompression supplemented with vertebroplasty with calcium sulphate and intermediate screws for patients with severe thoracolumbar burst fractures. Twenty-eight patients with thoracolumbar burst fractures of LSC point 7 or more underwent this procedure. The average follow-up was 27.5 months. Demographic data, radiographic parameters, neurologic function, clinical outcomes and treatment-related complications were prospectively evaluated. Loss of vertebral body height and segmental kyphosis was 55.3 % and 20.2° before surgery, which significantly improved to 12.2 % and 5.4° at the final follow-up, respectively. Loss of kyphosis correction was 2.2°. The preoperative canal encroachment was 49 % that significantly improved to 8.8 %. The preoperative pain and function level showed a mean VAS score of 9.2 and ODI of 89.9 % that improved to 1.4 and 12.9 % at the final follow-up, respectively. No implant failure was observed in this series, and cement leakage occurred in two cases without clinical implications. Excellent reduction and maintenance of thoracolumbar burst fractures can be achieved with short-segment pedicle instrumentation supplemented with anterior column reconstruction and intermediate screws. The resultant circumferential stabilization combined with a limited segmental decompression resulted in improved neurologic function and satisfactory clinical outcomes, with a low incidence of implant failure and progressive deformity.

Removal of spine instrumentation for the treatment of recurrent low back pain remains controversial in the absence of pseudarthrosis and when no obvious pain generators are present. It is our practice to offer these patients surgical exploration and removal of instrumentation. Forty-five patients underwent an anterior and posterior lumbar spinal fusion. The removal of instrumentation was performed by the same surgeon and senior author of this paper (MRP). The reason for the revision surgery was recurrent low back and leg pain. All patients had a solid fusion based on a thorough surgical exploration of the fusion mass. Instrumentation was deemed either solid or loose at time of removal based on the purchase at the screw-bone interface. Final outcomes were determined using a functional and satisfactory questionnaire and compared between the two groups (Loose Instrumentation versus Solid Instrumentation). The majority of the patients in both groups would recommend the surgery to a family member (79% overall), would have the surgery again themselves (82%) and consider the surgery a success (77%). Pain was significantly decreased from pre-operatively to post-operatively and from pre-operative to final follow-up in both groups. The group of patients with loose instrumentation were significantly more likely to have a successful outcome than the group without loose instrumentation. This study indicates that the removal of instrumentation in the absence of pseudarthrosis is beneficial in the relief of low back pain and leg pain symptoms. Increased success rates were noted in patients with loose instrumentation. However, this classification was based on inter-operative inspection. Further studies of the ability to diagnose and predict success prior to surgery needs to be done.

The purpose of this study was to identify risk factors for mechanical complications following complex spinal reconstruction for spondylectomy of primary spinal column tumors. A retrospective chart review identified patients treated with spondylectomy for primary spinal column tumors in the thoracic or lumbar spine followed by posterior instrumentation and anterior column reconstruction. Variables collected included basic demographics, smoking status, chronic steroid use, frailty (Charlson Comorbidity Index), extent of resection, Weinstein-Boriani-Biagini classification, tumor volume, Spine Instability Neoplastic Score, anterior column reconstruction and fixation techniques, rod characteristics, Hounsfield units (HUs), and neoadjuvant/adjuvant chemoradiation. Twenty-five patients were included (14 men, 11 women) with an average (± SD) age of 45 ± 18 years, BMI of 28 ± 5.7, and follow-up of 6.0 ± 6.2 years. Primary spinal column tumor pathology included chordoma (40%), chondrosarcoma (16%), giant cell tumor (16%), osteosarcoma (16%), osteoblastoma (8%), and aneurysmal bone cyst (4%). Six patients (24%) experienced mechanical complications, including rod fractures (n = 5) and distal junctional failure (n = 1). Of the 6 patients with mechanical complications, 4 (67%) underwent reoperation. The length of follow-up was the only statistically significant risk factor for patients with mechanical complications (average 11 years) compared to those without complications (average 4.4 years, p = 0.047). Average HUs were 144 for mechanical complication patients versus 180 for those without (p = 0.08). Anterior column reconstruction materials included a titanium cage (13 patients, 3 failures), structural allograft (6 patients, 2 failures), vascularized fibular strut autograft (6 patients, no failures), nonvascularized structural autograft (5 patients, 1 failure), vascularized rib autograft (5 patients, 2 failures), and a polyetheretherketone cage (2 patients, no failures). The vascularized fibular strut autograft had a 0% mechanical failure rate, but this did not reach statistical significance (p = 0.28). Twelve patients (48%) had anterior fixation placed, with a 17% rate of mechanical complications (p = 0.65). Five patients (20%) had > 2-rod constructs, with a 20% mechanical complication rate (p = 0.99). Reconstruction following primary spinal column tumor resection is a significant challenge, as evident by a high rate of mechanical complications and instrumentation failure. Future studies are needed with larger sample sizes to identify techniques that may mitigate the risk of failure.

Objective To explore different treatment choices for unilateral cervical facet locking. Methods The study involved 32 patients with cervical unilateral facet locking. Successful reduction by the skull traction was done in eight patients, of whom three were fixated by the head and neck chest plas-ter after a month of traction. Five patients were treated with anterior decompression and internal fusion fixation. The other 23 patients resulted in failure of traction and then were treated with anterior reduction, discectomy and internal fusion fixation in 14 patients, subtotal vertebral decompression and bone graft fix-ation in three, posterior open reduction and anterior bone graft fixation in one, posterior reduction, fixation and internal fusion fixation in three and posterior reduction and decompression plus anterior discectomy decompression and bone graft fixation in two. Due to misdiagnosis, one patient was treated with anterior decompression and fusion eight months after injury. Results A follow-up for average 18 months showed cervical instability in two patients who were treated with only traction, without fusion. The patients treated with anterior cervical fusion obtained bone union after 12 weeks, with satisfactory cervical physiological curvature and vertebral height. There were no internal fixation complications or neurological complications. Conclusions The treatment of lower cervical unilateral facet locking needs a compre-hensive considerations on whether there associates with disc injury, posterior column fractures or spinal cord injuries. As for patients with lower cervical unilateral facet locking combined with traumatic cervical disc herniation, the anterior reduction and decompression is the choice of treatment. While for those with-out disc herniation, traction or posterior open reduction and fixation can be carried out directly. Key words: Spinal injuries; Cervical vertebrae; Fracture fixation, internal; Bone fusion

Background Data: Short segment pedicular fixation is one of the most common operative techniques to treat unstable thoracolumbar burst fracture. However, it may be associated with pseudoarthrosis, progressive kyphosis, and a high rate of hardware failure. Different surgical techniques were described to deal with this failure. Biomechanical investigations have shown that anterior fusion provides superior stability as compared to single dorsal instrumentations.Study Design: A retrospective clinical case study. Purpose: To evaluate the outcomes of anterior column reconstruction for treatment of failed short segment pedicular fixation system in thoracolumbar fractures. Patients and Methods: This study included 25 patients with failed short segment pedicular fixation after acute thoracolumbar fracture. They were treated byanterior column reconstruction with strut iliac graft and fixed with either posterior long pedicular system or anterior locked system through simultaneous combined approaches. This study was done in the period between January 2009 to December 2013. Neurological status was classified using Frankel classification. All patients had been followed up by radiographs and CT-scans. Back pain and functional outcomes were assessed by VAS andODI respectively.Results: All patients were followed up for at least 24 months. The visual analogue scale (VAS) of back pain improved significantly from 6.20±0.94 preoperatively to 1.87±0.83 at the latest follow up. The mean Cobb angle improved significantly from 28.47±10.80o preoperatively to 2.07±9.39o immediate postoperatively and was maintained at 4.13±10.21o at latest follow up. According to Brantigan criteria, fusion was considered certain in all 25 patients (100%) and no failure of internal fixation occurred at latest follow up. The functional outcomes which measured by Oswestry disability index (ODI) improved significantly from 62.60±11.17% preoperatively to 24.00±6.04% at latest follow up.Conclusion: Anterior column reconstruction of the spine achieved significant improvement in radiological,clinical, and functional outcomes with few complications for treatment of failed short segment pedicular fixation in thoracolumbar fractures. (2015ESJ091)

To explore the feasibility and clinical effect of posterior spinal canal decompression with pedicle screw fixation and reconstruction of anterior and middle vertebral column for thoracolumbar burst fractures complicated with nerve injury. A total of 36 patients with thoracolumbar burst fractures treated from March 2011 to April 2016 were enrolled in the retrospective study. There were 20 males and 16 females, aged from 21 to 52 years old with an average of 37.6 years. All the fractures were located on a single segment, 8 cases of T11₁₁, 10 cases of T₁₂, 12 cases of L₁, 6 cases of L₂. According to thoracolumbar injury classification and severity score(TLICS) system, the score was 7 to 9 points, with an average of 7.4 points. According to the America Spine Injury Association(ASIA) grade, 4 cases were type A, 10 cases were type B, 14 cases were type C, 8 cases were type D. All the patients underwent posterior spinal canal decompression with pedicle screw fixation and reconstruction of anterior and middle vertebral column. The recovery of nerve function was evaluated by ASIA grading. The correction of kyphosis(Cobb angle), the volume change of injuried spinal canal, the change of anterior border height of injury vertebra which can be observed by X-rays;the internal fixation loosening and breakage and all the information of bone fusion were recorded. All the operations were successful, the mean operative time and intraoperative blood loss were(2.8±0.3) h (2.1 to 3.5 h) and (880±120) ml(550 to 1 350 ml), respectively. All the incisions got primary healing. All the patients were followed up for 12 to 28 months with an average of 18.4 months. All the patients obtained satisfactory bone fusion. No pseudoarticulation formation was found, and there was no loosening, breakage of pedicle screws or displacement of titanium mesh. Neurological function was improved in different degree, except in one patient with grade A and another one with grade B. According to the ASIA grade, there were 1 case of type A, 1 case of type B, 7 cases of type C, 10 cases of type D and 17 cases of type E, postoperatively. At 3 days after operative, the anterior border height of injury vertebra, Cobb angle and the volume changes of injury spinal canal were obviously improved(P<0.05), and there was no significant difference between postoperative at 3 days and final follow-up(P>0.05). Spinal canal decompression with screw fixation and reconstruction of anterior and middle vertebral column through posterior midline approach is a safe and effective method in the treatment of thoracolumbar burst fractures with nerve injury, it is worthy to be popularized. It can complete the spinal canal decompression of 360 degree, reduction of fractures and reconstruction of vertebral three-column at the same time through a single posterior approach. The advantages includes less trauma, perfect decompression, good stability and etc.

BACKGROUND: Thoracolumbar region (T11–L2) involvement is most common among the spinal injuries often associated with catastrophic neurodeficits. There are many classification systems to describe thoracolumbar fractures, but few have been useful in recommending surgical decision. The treatment of thoracolumbar fracture has been debated extensively. Optimal surgical approach to be used to treat thoracolumbar fractures remains controversial. MATERIALS AND METHODS: Thirty-four patients with thoracolumbar injury classification and severity score ≥5, who underwent posterior instrumentation, were studied prospectively between August 2018 and July 2021. Follow-up assessment was done using x-ray, American Spinal Injury Association (ASIA) impairment scale, Denis pain and work scale, and Oswestry disability index. RESULTS: Most of the patients were belonged to age group 31–40 years (44.1%, n = 15); L1 was the most common vertebra injured (61.8%, n = 21). Average kyphosis correction obtained by surgery was 10.53°, and the average loss of kyphosis correction at 2 years was 2.94°. Surgery duration and blood loss when compared between short-segment fixation (SSF) and long-segment fixation (LSF) showed a statistical significance (P < 0.0001). Associated injuries were seen in 11.76% (n = 4) of patients. At final follow-up, 85.71% (n = 24) of patients showed improvement to one higher ASIA grade; 82.4% (n = 28) of patients reported to have no pain or occasional minimal pain. CONCLUSIONS: Posterior pedicle screw-rod fixation is relatively safe, more familiar, and associated with less morbidity. Most of the fractures can be treated by SSF, but in patients with severe vertebral body comminution (AOtype A3) and AO type C fractures, LSF can be done.

Introduction The rigid angular kyphoses in the young patients with spinal TB are not only a cosmetic problem, they also lead to cardiovascular, respiratory, and neurological disorders. The correction of the deformity could be reached by combination of the debridement, anterior column reconstruction, the shortening of posterior spine, and extended posterior instrumentation. The zone of instrumentation needs to be longer than the anterior fusion for significant correction and spinal stability. Materials and Methods Total 13 children from 2.5 to 12 years with TB spondylitis of the thoracic and lumbar spine complicated by severe angular kyphosis underwent 1-day combined surgery included anterior debridement followed by cortical bone allografting and posterior osteotomy with correction and instrumentation by laminar or hybrid devises. The anterior reconstruction exceeded three segments in all cases (maximum-replacement of 10 vertebral bodies). For real deformity correction the posterior instrumented zone exceeded the length of anterior reconstruction up to 1 or 3 segments cephalad and caudad. The operations were performed under the SSEP monitoring and additionally with wake-up test-in older cases. Neither neurological nor inflammatory complications were in these patients. The normal or closed to the normal sagittal profile was reached in all cases. Follow-up period ranged from 2 till 13 years. Complete follow-up: 13 cases. All patients have annual X-ray control. There wasn't any signs of anterior pseudo-arthrosis revealed. The condition of subchondral vertebral plates and the height of intact intervertebral disks within the zone of instrumentation and disks adjacent to the instrumented spine were compared. Results Total 11 of 13 operated patients (85%) demonstrated degeneration of initially intact disks within the instrumented spine 2 years after the surgery. The signs included loss of disk height, sclerosis, and deformation of subchondral vertebral plates. Despite nobody had back pain, the main parents' complaint was the limitation of spine range of motion. We've decided to count the early symptoms of disk degeneration, the indication to remove spinal hardware having solid anterior fusion documented. There was no increase of kyphosis, excluding one case of conjunctive deformity above the instrumented spine. Conclusion The intervertebral disks degeneration within the instrumented zone is a typical side effect of prolonged posterior rigid instrumentation in growing spine. After 2 years of surgery, it occurred in a majority of pediatric patients who had been operated due to the thoracic and lumbar spinal TB complicated by kyphosis exceeded 50ø. This degeneration was not accompanied by the pain during the childhood, but it may become symptomatic in adulthood. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared

IntroductionIn combined posterior–anterior stabilization of thoracolumbar burst fractures, the expandable vertebral body replacement device (VBRD) is typically placed bisegmentally for anterior column reconstruction (ACR). The aim of this study, however, was to assess feasibility, outcome and potential pitfalls of monosegmental ACR using a VBRD. In addition, clinical and radiological outcome of monosegmental ACR was related to that of bisegmental ACR using the same thoracoscopic technique.MethodsThirty-seven consecutive neurologically intact patients with burst fractures of the thoracolumbar junction (T11–L2) treated by combined posterior–anterior stabilization were included. Monosegmental ACR was performed in 18 and bisegmental ACR in 19 patients. Fracture type and extent of vertebral body comminution were determined on preoperative CT scans. Monosegmental and bisegmental kyphosis angles were analyzed preoperatively, postoperatively and at final radiological follow-up. Clinical outcome was assessed after a minimum of 2 years (74 ± 45 months; range 24–154; follow-up rate 89.2%) using VAS Spine Score, RMDQ, ODI and WHOQOL-BREF.ResultsMonosegmental ACR resulted in a mean monosegmental and bisegmental surgical correction of − 15.6 ± 7.7° and − 14.7 ± 8.1°, respectively. Postoperative monosegmental and bisegmental loss of correction averaged 2.7 ± 2.7° and 5.2 ± 3.7°, respectively. Two surgical pitfalls of monosegmental ACR were identified: VBRD positioning (1) onto the weak cancellous bone (too far cranially to the inferior endplate of the fractured vertebra) and (2) onto a significantly compromised inferior endplate with at least two (even subtle) fracture lines. Ignoring these pitfalls resulted in VBRD subsidence in five cases. When relating the clinical and radiological outcome of monosegmental ACR to that of bisegmental ACR, no significant differences were found, except for frequency of VBRD subsidence (5 vs. 0, P = 0.02) and bisegmental loss of correction (5.2 ± 3.7° vs. 2.6 ± 2.5°, P = 0.022). After exclusion of cases with VBRD subsidence, the latter did not reach significance anymore (4.9 ± 4.0° vs. 2.6 ± 2.5°, P = 0.084).ConclusionsThis study indicates that monosegmental ACR using a VBRD is feasible in thoracolumbar burst fractures if the inferior endplate is intact (incomplete burst fractures) or features only a single simple split fracture line (burst-split fractures). If the two identified pitfalls are avoided, monosegmental ACR may be a viable alternative to bisegmental ACR in selected thoracolumbar burst fractures to spare a motion segment and to reduce the distance for bony fusion.