Abstract
Background: The surgical treatment of unstable burst fracture (TLICS >4) of the thoracolumbar vertebrae remain controversial. This study is aimed to compare the short segment versus long-segment posterior fixation for thoracolumbar burst fracture.The objective of the study is to study comparison of outcome of the Short-Segment Posterior Fixation (SSPF) versus Long-Segment Posterior Fixation (LSPF) for treatment of thoracolumbar burst fracture in term of surgical, radiological, neurological and functional outcome. Subjects & Methods: In this prospective study, we included 32 patients with Burst fracture AO type A3, A4 of Thoracolumbar spine (T10-L2), who underwent posterior pedicle screw fixation for Burst fracture Thoracolumbar spine. A total of 18 of the patients underwent Short-Segment Posterior Fixation (SSPF) (Group A); group A is further divided into three subgroups A1: short-segment only(n=10), A2: short-segment with index screw(n=4) and A3: short-segment with anterior column reconstruction(n=4) with cage, Whereas 14 patients had Long-Segment Posterior Fixation (LSPF) (Group B). Surgical (duration of surgery, blood loss, complication), Clinical (Oswestry questionnaire, spinal cord independent measuring scale), radiological (percentage of anterior body height compression, kyphosis correction loss, Mc Cormack classification) and Neurological (Frankel grading) outcomes were analyzed. Results: The operative time Group A (159.85 min 22.5) was significantly shorter than Group B (198.7 31.5). Blood loss was significantly less in Group A (478 ml 259.3) than Group B (865ml 275.7). Kyphosis Correction loss at 6th month follow up in Group A (subgroup A1: 10.7deg 6.2, subgroup A2: 7.1deg 7.4 and subgroup A3: Subgroup A3: 6.1deg 5.2) was higher than that of group B (6.2deg 6.3). Complication (surgical site infection) occurred in Two patients in group B. There was no significant difference in terms of improvement in functional and neurological outcomes among both groups. The functional outcomes as per the SCIM and ODI score at 6th month follow up in group A: 74.7 +-22.29, 31.5+-13.73 respectively, and group B: 73.8+-26.07, 26.7+-17.9, respectively. Conclusion: Short-Segment Posterior Fixation (SSPF) is a significantly decreased duration of surgery and blood loss compare with Long-Segment Posterior Fixation (LSPF). Loss of kyphosis correction in Short-Segment Posterior Fixation (SSPF) may be decreased with index screws or anterior column reconstruction.
Highlights
Denis et al 1983 defined the burst fracture in his 3-column theory as a compression fracture of the anterior and middle vertebral columns, which causes retropulsion of a posterior vertebral body fragment into the spinal canal.[1]
A total of 18 of the patients underwent Short-Segment Posterior Fixation (SSPF) (Group A); Group A is further divided into three subgroups A1: short-segment only (n=10), A2: short-segment with index screw(n=4) and A3: shortsegment with anterior column reconstruction(n=4) with cage, whereas 14 patients had Long-Segment Posterior Fixation (LSPF) (Group B)
Pedicle screws were inserted one level above and below the fractured vertebra for Short-Segment Posterior Fixation (SSPF) (Group A) and two or more than two levels above and below for Long-Segment Posterior Fixation (LSPF) (Group B) and fixed with the rod on one side provisionally followed by Posterior or Poster lateral decompression and the anterior column was reconstructed using either cage filled with graft or graft alone
Summary
Denis et al 1983 defined the burst fracture in his 3-column theory as a compression fracture of the anterior and middle vertebral columns, which causes retropulsion of a posterior vertebral body fragment into the spinal canal.[1]. This study is aimed to compare the short segment versus long-segment posterior fixation for thoracolumbar burst fracture.The objective of the study is to study comparison of outcome of the Short-Segment Posterior Fixation (SSPF) versus Long-Segment Posterior Fixation (LSPF) for treatment of thoracolumbar burst fracture in term of surgical, radiological, neurological and functional outcome. Surgical (duration of surgery, blood loss, complication), Clinical (Oswestry questionnaire, spinal cord independent measuring scale), radiological (percentage of anterior body height compression, kyphosis correction loss, Mc Cormack classification) and Neurological (Frankel grading) outcomes were analyzed. Conclusion: Short-Segment Posterior Fixation (SSPF) is a significantly decreased duration of surgery and blood loss compare with Long-Segment Posterior Fixation (LSPF). Loss of kyphosis correction in Short-Segment Posterior Fixation (SSPF) may be decreased with index screws or anterior column reconstruction
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