ABSTRACT

Objective: There is some debate as to which is the best approach (decompression technique and how many levels of pedicle screws to use) in the surgical treatment of thoracolumbar fractures. Correction of thoracolumbar kyphosis without a neurological injury and prevention of mechanical problem should be the main concern. The aim of this study is to evaluate the advantages of long segment fusion with screws placed at the fracture level in unstable thoracolumbar vertebral fractures.

Methods: Ninety-one patients with unstable T11-L2 burst fractures operated between January 2014 and March 2021 were included in the study. The patients were divided into two groups as those with screws placed in the fractured vertebra (group A: n: 61, age: 40.3) and those without (group B: n: 30, age: 38.9). All patients were followed up periodically with clinical and radiological evaluation. Vertebral compression angle (VCA), vertebral corpus height (VCH), intraoperative parameters (instrumentation time and intraoperative fluoroscopy number) and complications were compared between the groups.

Results: There was no statistical difference with respect to age, sex, level of injury, AO classification, mechanism of injury and ASIA (American Spinal Cord Injury Association) classification between the groups. The both groups significantly restored VCA and VCH after operation (p < 0.0001). Improvement in early postoperative VCA was statistically significantly better in Group A (p=0.0144). At the last follow-up, the Group A was significantly more succesful in restoration and protection of achieved correction of VCA (p = 0.0003). There was no difference between the two groups in terms of correction loss in VCA measured at the last follow-up. There was no statistically significant difference between the two groups in terms of postoperative VCH, VCH at the last follow- up, and correction loss in VCH. There was a statistical significant difference in operation time and intraoperative fluoroscopy numbers in group A compared to group B (p = 0.0443, p < 0.0001 respectively). Implant failure occurred in two patients in group A and one patient in group B.

Conclusion: Although it increases operative time, intraoperative blood loss, and the number of intraoperative fluoroscopy, the use of pedicle screw to fractured vertebra in long segment fusion is more effective in preventing mechanical problem in unstable burst fractures. It provides better postoperative correction in fractured vertebrae. However, there was no difference between the two groups in terms of loss of correction at follow-up.

Keywords: Thoracolumbar fractures, long segment fixation, intermediate screw, pedicle screw fixation, fracture level .