Case control studies on unilateral or bilateral pedicle fixation at the level of fracture versus posterior fixation alone in the treatment of thoracolumbar fractures

Abstract

To compare the clinical effects of three fixation methods at the level of fracture in treating thoracolumbar fractures. From June 2012 to June 2015, 67 patients with thoracolumbar fractures were treated with posterior short-segment pedicle fixation. There were 45 males and 22 females, aged from 13 to 63 years old with an average of 42.5 years. According to the methods of fixation at the level of fracture, the patients were divided into three groups. Group A included 26 patients treated by traditional posterior fixation alone. Group B included 19 patients treated by posterior fixation with unilateral pedicle fixation at the level of fracture. In group C, 22 patients were treated by posterior fixation with bilateral fracture-level screws. Radiological parameters and clinical outcomes were compared among the three groups. All the patients were followed up for 12 to 26 months with an average of 17.6 months. No complications such as incision infection, poor wound healing, internal fixation loosening and breakage were found. Preoperative, postoperative 1 week, and final follow-up, there were no significance differences among the three groups with respect to the relative height of the fractured vertebra (P>0.05). The sagittal Cobb angles among the three groups were similar preoperatively, and a week after operation (P>0.05). At latest follow-up, the sagittal Cobb angles and the correction loss of Cobb angle in group A were significantly larger than that of groups B and C (P<0.05), while there was no statistical difference between group B and group C (P>0.05). With respect to visual analogue scale (VAS) scores for back pain, the three groups were similar at preoperatively, a week after operation and the latest follow-up(P>0.05). Compared to traditional posterior fixation alone, unilateral or bilateral pedicle fixation at the level of fracture can significantly decrease the loss of correction in the middle-long term, and reduce the incidence of tardive kyphosis deformity and can obtain satisfactory radiological results and clinical outcomes with safe surgical procedures.