Comparison of posterior short segment fixation with versus without inclusion of the fracture level in the treatment of mild to moderate thoracolumbar burst fractures

English Keywords:Thoracolumbar burst fracture  Intermediate screw  Load sharing classification  Short segment fixation  Posterior

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacy of posterior short-segment pedicle screw fixation (SSPF) with posterior short-segment fixation including the fractured vertebra(PSFFV) in the treatment of mild to moderate thoracolumbar burst fractures(TBFs). Methods: The clinical data of 60 patients(33 males, 27 females) with mild and moderate thoracolumbar fractures treated with posterior short segment fixation in Dongguan Third People′s Hospital from June 2012 to June 2016 were analyzed retrospectively. The age range was 25-55 years old(39.4±8.4) with: T11 fracture in 3 cases, T12 fracture in 8 cases, L1 in 10 cases, L2 in 6 cases, and L3 in 2 cases. AO classification of all the patients was A3, load sharing score(LSC) was 3-5, thoracolumbar injury classification and severity score(TLICS) ≥4 points, and all patients were followed up for more than 1.5 years(18.8±2.8 months). 29 cases (4 screws) were included in short-segment pedicle screw fixation(SSPF group) and 31 cases(6 screws) in posterior short-segment fixation including the fractured vertebra (PSFFV group). The age, sex, body mass index, fracture position, load sharing score (load-sharing classification, LSC), TLICS score, AO classification, operation time, intraoperative bleeding, postoperative drainage, complications, hospitalization time and cost were compared between the two groups. The anterior edge height of fractured vertebra, cuneiform angle, and visual analog scale(VAS) of low back pain at preoperative, 1 week after operation and final follow-up were measured and compared, and so was the fracture healing time, and time of returning to work. Results: There were no significant differences in age, sex, body mass index, fracture segment, LSC score, TLICS score and AO classification between the two groups(P>0.05). SSPF group was superior to PSFFV group in operation time, postoperative drainage and hospitalization expenses, with significant differences between the two groups(P<0.05). There were no significant differences in intraoperative bleeding and hospitalization time between the two groups(P>0.05), with no serious complications such as intraoperative vascular injury, spinal nerve root injury and postoperative wound infection in both groups. Comparing with that before operation, the cuneiform angle, anterior edge height of fractured vertebra, and VAS score at 1 week after operation were significantly improved(P<0.05), and there were no significant differences in cuneiform angle and anterior edge height between the last follow-up and 1 week after operation (P>0.05), yet VAS score at the final follow-up was significantly different from that at 1 week after operation (P<0.05). There were no significant differences in cuneiform angle, anterior edge height, VAS score between the two groups before operation, at 1 week after operation and last follow-up, and also there were no significant differences in fracture healing and return-to- work time between the two groups(P>0.05). Conclusions: Both posterior short segment fixation with and without inclusion of the fracture level are safe and effective in the treatment of mild to moderate thoracolumbar burst fractures, which can restore and maintain spinal stability.