Posterior Spinal Fixation with Fusion versus without Fusion in Treatment of Dorsolumbar and Lumbar Fractures

Abstract

IntroductionOperative treatment in the form of posterior fixation with or without fusion has moved to the forefront of fracture management as it helps decreasing morbidity and mortality with better return to work and satisfactory functions. The aim of the study is to compare the results of posterior spinal fixation with fusion versus without fusion in cases of dorsolumbar and lumbar fractures both clinically and radiologically. Material and MethodsA randomized clinical trial conducted on 60 patients in Ain Shams University Hospitals in two groups: Group (A): posterior spinal fixation with fusion (30 patients); Group (B): posterior spinal fixation without fusion (30 patients). All patients have dorsolumbar and/or lumbar spine fractures and are candidates for posterior spinal fixation. Inclusion criteria: Age group (<45 years). Both sexes. Neurologically intact patients with kyphotic angle more than 20° or decreased vertebral body height more than 50% or a canal compromise more than 50%. Single or multilevel spinal injury. Exclusion criteria: Any patient who will need anterior fusion according to load sharing classification (≥7). Incomplete or complete neurological deficit. Advanced spondylosis. Fracture of pars interarticularis. Fracture of facet joints. Preoperative evaluation includes history, examination, and radiological evaluation. All patients were done under general anesthesia in prone position. A standard midline posterior approach was used to expose the desired levels for fixation. Posterior instrumentation using pedicular screws (in non-fusion group, only top loading rod systems were used as side loading and plate systems may damage facet joints). Posterior and intertransverse fusion was used in fusion group. ResultsOperative time was shorter in non-fusion group (107.5 minute) than fusion group (140.83 minute). Intraoperative blood loss was less in non-fusion group (330.33 ml) than fusion group (368.33 ml). The mean of lost correction of vertebral body height % in fusion group was 7.9 while the mean of lost correction of vertebral body height % in non-fusion group was 8.07. This is statistically not significant with P-value > 0.05 (0.917). The mean of lost correction of Cobb angle in fusion group was 6.7° while the mean of lost correction of Cobb angle in non-fusion group was 8.65°. This is statistically significant with P-value < 0.05. The mean segmental motion after removal in fusion group was 1.73° while the mean segmental motion after removal in non-fusion group was 11.62°. This is statistically significant with P-value < 0.001. ConclusionPosterior spinal fixation without fusion yielded satisfactory results similar to those of posterior spinal fixation with fusion in patients with dorsolumbar fractures with a load sharing score < 7.