Clinical comparison of type Ⅳ short and long segment fixation for acute symptomatic osteoporotic thoracolumbar fractures

English Keywords:ASOTLF classification  Osteoporosis  Spinal fracture  Thoracic vertebra  Lumbar vertebra

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacy of type Ⅳ short segment fixation and long segment fixation in acute symptomatic osteoporotic thoracolumbar fracture(ASOTLF). Methods: Clinical data of patients with osteoporotic thoracolumbar fracture(OTLF) admitted to our hospital from January 2016 to December 2019 were retrospectively analyzed by ASOTLF classification, among which 35 cases were classified as type Ⅳ. They were divided into two groups according to the length of fixed segments. Group A was the short segment fixation group(the injured vertebrae and its upper and lower one normal segment), and group B was the long segment fixation group(the injured vertebrae and its upper and lower 2 normal segments). In group A, the injured vertebrae were reinforced with bone cement, followed by pedicle screw fixation and nail channel reinforcement in both upper and lower vertebrae. In group B, the injured vertebrae were strengthened with bone cement and screw fixation, and two groups of pedicle screws were fixed on the upper and lower vertebrae, and the screw channel was strengthened. In both groups, posterior fixed segmental facet joint bone graft fusion was performed. In group A, there were 18 patients, 6 males and 12 females, aged 72.1±3.5 years, were followed up for 12.0±3.3 months with the T-value of lumbar bone mineral density(BMD) of -3.2±0.2. There were 17 patients in group B, including 7 males and 10 females, aged 72.4±3.5 years, the T-value of lumbar BMD was -3.1±0.4, and the follow-up time was 15.3±2.8 months. The gender, age, follow-up time, operation time, intraoperative blood loss, bone cement leakage, adjacent vertebral fracture rate, visual analogue scale(VAS), Oswestry disability index(ODI) and kyphotic angle changes before and after surgery were compared between the two groups, and complications were recorded. Results: There were no statistically significant differences in age, gender, BMD T-value, VAS score, ODI, and kyphotic angle between the two groups before surgery(P＞0.05); the operation time(63．7±10．6min vs 93．5±12．1min) and intraoperative blood loss(205．3±28．4ml vs 326．0±37．9ml) in group A were less than those in group B; the VAS score, ODI, and kyphotic angle of the two groups were significantly improved at 7 days after surgery and at final follow-up(P＜0.05) than those before operation, and there was no significant difference between groups(P＞0.05). No significant difference was found in cement leakage(4/18 vs 3/17) and other vertebral fractures(2/18 vs 1/17) between the two groups. Conclusions: In type Ⅳ acute symptomatic osteoporotic thoracolumbar fracture, short-segment or long-segment posterior fixation can both achieve satisfactory reduction, clinical efficacy and deformity correction of injured vertebrae. Short-segment fixation has more advantages in operative time and intraoperative bleeding.