Abstract
Choice of long or short segment fixation for thoracolumbar fractures, benefits of either of these techniques has been a topic for analysis and assessment. Kyphotic angles in twenty patients diagnosed to have thoracolumbar vertebral fractures between December 2019 to December 2020 in Bapuji hospital and Chigateri general hospital, Davanagere, Karnataka, India were measured pre operatively, post operatively and at one year follow up and assessed. No statistical difference between the degrees of correction of initial kyphotic angle between long segment fixation and short segment posterior fixation in our study was found (p<0.6). Method of fixation of the thoracolumbar vertebral fracture did not correlate with initial degree of kyphosis (p=0.4). Amount of correction loss at one year follow up was found to be statistically significant in short segment fixation (p<0.05). Loss of kyphotic angle at one year follow up was higher in case of short segment fixation than long segment fixation and found to be statistically significant (p<0.005). Our study showed that long segment fixation helps in better correction of the kyphosis angle with lesser chance of loss of correction and can be opted when pedicles aren’t intact at the fracture level, as in cases of burst fractures. Short segment fixation provides better rigid fixation at the site of fracture with increased range of motion at the thoracolumbar segment and can be treatment of choice when the pedicles at the fractured level are intact, as in cases of compression fractures, having benefits of shorter duration of surgery and reduced risks.
Highlights
The second most commonly involved spinal segment injuries after cervical segment is the thoracolumbar spinal segment, about 30 to 60% of all spinal injuries. 60% of thoracolumbar injuries in trauma are concentrated between T12 and L2 vertebrae [1]
The mean degree of correction of the kyphotic angle immediate post operatively was found to be better in case of long segment fixation of lumbar vertebral fracture than that of short segment fixation
Our study showed that loss of kyphotic angle at one year follow up was statistically higher in case of short segment fixation than long segment fixation and found to be statistically significant (p
Summary
The second most commonly involved spinal segment injuries after cervical segment is the thoracolumbar spinal segment, about 30 to 60% of all spinal injuries. 60% of thoracolumbar injuries in trauma are concentrated between T12 and L2 vertebrae [1]. 60% of thoracolumbar injuries in trauma are concentrated between T12 and L2 vertebrae [1]. This motion segment connects the relatively rigid, kyphotic thoracic spine which is stabilized by the rib cage to the more mobile lordotic lumbar vertebrae. Surgical options include an anterior approach, a posterior approach, or a combined antero-posterior approach. Low lumbar injuries can be treated by posterior approach usually resulting in spinal cord injuries. Antero-posterior surgeries typically are reserved for highly unstable fracture subluxations [4]. As most orthopedic and spinal surgeons are more experienced in posterior approach and at the same time this approach and involves less operative time and less blood loss is considered be a safer approach [5]
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