Short-Segment Posterior Fixation with Intermediate Screws for Unstable Thoracolumbar Fractures

The optimal surgical approach for unstable thoracolumbar fractures remains debated. Posterior fixation including the fractured vertebra (PFFV) has been proposed to balance stability and preservation of motion segments.

We retrospectively reviewed 161 patients with severe unstable thoracolumbar fractures treated with PFFV between 2014 and 2021 at a tertiary center in Jordan. Demographic, operative, radiological, and functional outcomes were assessed preoperatively, at discharge, and at a minimum of 24 months follow-up. Radiological parameters included kyphotic Cobb angle, anterior body compression percentage, and local kyphotic angle. Functional outcomes included American Spinal Injury Association (ASIA) Impairment Scale grade, Oswestry Disability Index, and visual analog scale.

All patients underwent successful PFFV with no implant failures and a low complication rate (4% wound infections). Radiological outcomes improved significantly and were largely maintained at final follow-up, with Cobb angle decreasing from 22.0° to 11° (P < 0.001) and anterior body compression percentage from 52% to 26% (P < 0.001). Postoperatively, most patients demonstrated neurological improvement, with notable transitions from ASIA B-D to higher grades, while all ASIA A and E patients remained unchanged. Patient-reported outcomes were favorable (mean Oswestry Disability Index 16%, mean visual analog scale 2). Subgroup analysis demonstrated statistically significant, though clinically modest, differences in kyphotic correction based on patient gender and intermediate screw configuration.

Our findings support the use of PFFV for patients with severe unstable thoracolumbar fractures. Future prospective controlled trials are necessary to establish direct comparative superiority to other surgical techniques.