Abstract
In order to compare short-segment stabilization with long-segment stabilization for treating unstable thoracolumbar fractures, we studied fifty patients suffered from unstable thoracolumbar burst fractures. Thirty of them were managed with long-segment posterior transpedicular instrumentation and twenty patients with short-segment stabilization. The mean follow up period was 5.2 years. Pre-operative and post-operative radiological parameters, like the Cobb angle, the kyphotic deformation and the Beck index were evaluated. A statistically significant difference between the two under study groups was noted for the Cobb angle and the kyphotic deformation, while, as far as the Beck index is concerned, no significant difference was noted. In conclusion, either the long-segment or the short-segment stabilization is able for reducing the segmental kyphosis and the vertebral body deformation postoperatively. However, as time goes by, the long-segment stabilization is associated with better results as far as the radiological parameters, the indexes and the patient’s satisfaction are concerned.
Highlights
The restoration of the vertebral column stability and the decompression of the spinal canal are the goals of the treatment of thoracolumbar fractures
The highest rate of the instrumentation failure resulting in re-kyphosis of the entire segment is associated with SS posterior reduction and stabilization of burst fractures showing the inadequacy of the SS transpedicular instrumentation used for the treatment of thoracolumbar and lumbar fractures [2]
There is homogeneity between the SS pedicle instrumentation versus LS pedicle instrumentation of Low Back Outcome Score (LBOS) four categories: Poor, (5% vs 0%); Fair, (30% vs 30%); Good, (45% vs 53.3%); Excellent, (20% vs 16.7%)
Summary
The restoration of the vertebral column stability and the decompression of the spinal canal are the goals of the treatment of thoracolumbar fractures. It has been demonstrated that short-segment (SS) instrumentation is associated with an unacceptable rate of failure [1]. The highest rate of the instrumentation failure resulting in re-kyphosis of the entire segment is associated with SS posterior reduction and stabilization of burst fractures showing the inadequacy of the SS transpedicular instrumentation used for the treatment of thoracolumbar and lumbar fractures [2]. Bent screws and kyphosis did not always herald a clinical failure, but patients who have kyphosis more than 10 degrees even if it is progressively increased, feel substantially more pain that those who have little or no loss of correction of the fractured vertebral body [3]. Significant correction loss and failure was found in long-segment (LS) instrumentation [2]
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