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Updated: Oct 24, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Radiographic Performance of Direct, Indirect, and Combined Reduction Techniques in AO A3/A4 Thoracolumbar Burst
Sagar Gurnani1, Navendu Gadhia, Goli Sudheer
1Department of Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India.
Background:
Optimal reduction of retropulsed canal fragments in thoracolumbar burst fractures remains debated. This secondary analysis compared computed tomography (CT)-based canal restoration after indirect ligamentotaxis, direct fragment impaction, and combined reduction.
Materials And Methods:
Anonymized patient-level and aggregate data from an open-access cohort of 34 single-level AO A3/A4 thoracic or lumbar burst fractures were analyzed. Patients underwent bisegmental posterior stabilization using indirect, direct, or combined reduction. Preoperative spinal canal area (SCA) stenosis and midsagittal diameter (MSD) stenosis were available at the patient level, whereas postoperative SCA and MSD were available as group means.
Results:
Thirteen patients underwent indirect reduction, 13 underwent direct reduction, and eight underwent combined reduction. Mean age was 36.4 ± 14.1 years; 23 patients were male. Mean SCA stenosis decreased from 43.7% to 16.6% after indirect reduction, 63.0% to 12.7% after direct reduction, and 48.0% to 11.6% after combined reduction. Direct reduction cases had higher preoperative SCA stenosis than indirect reduction cases (Mann-Whitney U-test P = 0.014).
Conclusion:
All three techniques achieved substantial radiographic canal restoration. Direct reduction was preferentially used for more severe canal compromise, supporting morphology- and stenosis-guided reduction selection. Prospective local validation with patient-level postoperative CT and functional outcomes is required.
