Comparison of Four Different Posterior Screw Fixation Techniques for the Treatment of Thoracolumbar Junction Fractures

Abstract

The purpose of this study was to compare clinical and radiologic outcomes of patients who underwent short-segment posterior instrumentation with screw augmentation at the fracture level and long-segment instrumentation for thoracolumbar junction fractures. Sixty-three patients were retrospectively evaluated by being divided into the following 4 groups: Groups A, B, C, and D included patients who had undergone 4-level instrumentation without insertion of screws at the fracture level, 3-level instrumentation by insertion of screws at the fracture level, 4-level instrumentation by insertion of screws at the fracture level, and 5-level instrumentation by insertion of screws at the fracture level, respectively. No significant difference was observed in preoperative local kyphosis angle (LKA) (P > 0.05), whereas there was a significant decrease in early postoperative LKA in Group C compared with the other groups (P < 0.05). However, there was no significant difference of LKA in the 4 groups measured on radiographs obtained at the final follow-up (P > 0.05). Anterior corpus height loss, Cobb angle of the fractured vertebra, and sagittal index, measured pre- and postoperatively and at the final follow-up, showed no significant difference (P > 0.05). There was no statistically significant difference between clinical scores of the 4 groups (P > 0.05). Short-segment posterior instrumentation with screw augmentation at the fracture level provides at least as much mechanical stability as long-segment instrumentation. Moreover, there is no difference between short-segment instrumentation with screw augmentation at the fracture level and long-segment instrumentation in terms of clinical outcomes.