Is it possible to save one lumbar segment in the treatment of thoracolumbar fractures?

Surgical treatment of unstable thoracolumbar fractures is controversial. Most authors reported that short segment fixation led to a high incidence of implant failure and correction loss. On the other hand, long segment fixation has the disadvantage of fusing more segments. We aimed to compare the outcomes of long-segment fixation versus two or three levels above and one level below fixation for acute thoracolumbar fractures. Twenty six consecutive patients were assigned to two groups. Group 1 included 14 patients treated with long fixation, whereas group 2 included 12 patients treated with two or three levels above and one level below fixation. Fractures were classified according to the Mc Cormack, Magerl and Denis classifications. Clinical (Oswestry questionnaire, Visual analog score) and radiological (Sagittal index, percentage of anterior body height compression, local kyphosis and Cobb angle) outcomes were analysed. The average follow-up for the long and hybrid fixation groups were 28 and 20 months respectively. Clinical scores of both groups at the last follow-up were not significantly different. The preoperative, postoperative and follow-up sagittal index, anterior body height compression, local kyphosis angle and Cobb angle were not significantly different. Correction loss of 3.36 degrees was seen in the long segment fixation group, versus 2.75 degrees in the other group at the last follow-up. There was no significant difference between the results achieved in the patients who had transpedicular fixation two or three levels above and one level below the fractured vertebra and those who had long segment fixation for thoracolumbar burst fractures.