Single vs Double Index Screws in Thoracolumbar Burst Fractures: A Retrospective Analysis

Area of Science:

• Orthopedic Surgery
• Spinal Surgery
• Traumatology

Background:

• Thoracolumbar burst fractures are common spinal injuries.
• Short-segment posterior stabilization is a standard treatment.
• The choice between single-index screws (SIS) and double-index screws (DIS) at the fractured vertebra is debated.

Purpose of the Study:

• To compare the radiological, clinical, and neurological outcomes of SIS versus DIS in short-segment posterior stabilization for thoracolumbar burst fractures.
• To evaluate the long-term effectiveness of these fixation methods.

Main Methods:

• Retrospective study of 94 patients with AO type A/B thoracolumbar burst fractures.
• Patients underwent short-segment posterior stabilization using either SIS or DIS.
• Radiological parameters (Cobb's angle, vertebral wedge angle, vertebral body compression ratio) and clinical outcomes (VAS, ODI, ASIA Impairment Scale) were assessed over a minimum 2-year follow-up.

Main Results:

• Double-index screws (DIS) demonstrated significantly better maintenance of Cobb's angle, vertebral wedge angle, and vertebral body compression ratio compared to single-index screws (SIS).
• Clinical outcomes, including Visual Analog Scale (VAS) for back pain and Oswestry Disability Index (ODI), showed a trend favoring DIS but were not statistically significant.
• No significant differences were observed in neurological outcomes (ASIA Impairment Scale) or spinal canal remodeling (transverse spinal area).

Conclusions:

• Short-segment posterior stabilization with DIS provides superior radiological outcomes in terms of maintaining spinal alignment and vertebral body integrity compared to SIS.
• Clinical and neurological outcomes are comparable between SIS and DIS fixation methods for thoracolumbar burst fractures.
• DIS may be preferred for achieving better long-term radiological stability in these injuries.