Posterior Short-segmental Fixation Combined With Intermediate Screws vs Conventional Intersegmental Fixation for Monosegmental Thoracolumbar Fractures

Abstract

Posterior short-segmental fixation is reliable for the management of thoracolumbar fractures; however, it is associated with recurrence of kyphosis and failure of fixation. This study compared the short-term results of short-segmental fixation combined with intermediate screws with those of conventional intersegmental fixation in the treatment of monosegmental thoracolumbar fractures. The records of 62 consecutive patients with thoracolumbar monosegmental fractures who underwent conventional 4-screw intersegmental fixation (35 patients) or short-segmental fixation combined with intermediate screws (27 patients) were reviewed. The study population included 43 men and 19 women (mean age, 44.1±13.6 years). The majority of fractures were L1 (28 [45.1%]) and T12 (21 [33.9%]) fractures. There were no significant differences between the 2 groups with respect to the preoperative relative height of the fractured vertebra or the segmental kyphotic angle. There was a significant difference in the restoration rate between the conventional and short-segmental fixation groups (62.6±38.7% vs 100.4±25.4%, respectively; P<.001). However, a statistically significant decrease in postoperative segmental kyphotic angle was noted in both groups (P<.001). The mean change of segmental kyphotic angle in the short-segmental fixation group was greater than in the conventional fixation group (14.4±6.8° vs 8.3±7.9°, respectively; P<.002). Patients in the short-segmental fixation group ambulated an average of 10 days earlier than those in the conventional fixation group. These findings indicate that compared to conventional intersegmental fixation, short-segmental fixation combined with intermediate screws more effectively restores fractured vertebral height, is associated with a decrease in the segmental kyphotic angle, and allows earlier ambulation.