Short-segment versus Long-segment Stabilization for Unstable Thoracolumbar Junction Burst Fractures

The treatment of unstable thoracolumbar junction burst fractures remains a controversial issue. We evaluate the efficacy of short segment (SS) compared with that of long-segment (LS) stabilization in terms of clinical and the radiological outcomes. Records of 88 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation from January 2004 to December 2015, studied retrospectively. These patients were divided into two groups: SS and the LS-group. Clinical parameters: back pain, disability, neurological deficit and radiologic parameters: Cobb angle, sagittal index, the kyphotic deformation of vertebral body, vertebral height and canal compromise were measured before surgery and immediately after surgery and at 3, 6 and 12 months postoperatively. Overall outcomes were evaluated using the modified Mcnab criteria at the last follow-up. Chi-squared test and paired-t test were used for statistical analysis using SPSS. There were 36 and 52 patients in the SS and LS- group, respectively. The mean age of the patients was 30.6±8.4 and 33.4±8.4 years and the mean follow-up period was 24.5 and 16.8 months in SS and LS-group respectively. In the SS-group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 15, 10, 6, 3 and 2 cases and LS- group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 22, 17, 5, 5 and 3 cases, respectively. Both groups achieved satisfactory clinical outcomes according to the modified Mcnab criteria. In the SS-group, 8(22.22%), 21(58.33%) and 7(19.44%) cases were considered to have excellent, good and fair outcome and LS-group, 18(34.61%), 25(48.08%), 6(11.54%) and 3(5.77%) cases were considered to have excellent, good, fair, and poor outcome, respectively. Short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar junction burst fracture.