J Korean Soc Spine Surg.  2013 Jun;20(2):44-50. 10.4184/jkss.2013.20.2.44.

Comparison of Short Segment and Long Segment Posterior Instrumentation of Thoracolumbar and Lumbar Bursting Fractures at Load Sharing Score 7 or Above

• Na HY
• Lee YS
• Choi JC
• Kim WS
• Song WS
• Jung YH
• Park TH
• Kim TH
• Seo KW

• KMID: 1430374
• DOI: http://doi.org/10.4184/jkss.2013.20.2.44

Abstract

STUDY DESIGN: A retrospective comparative analysis of the short-segment and long-segment posterior fixation in thoracolumbar burst fractures that are 7 points or above in load-sharing score was performed.
OBJECTIVES
The purpose of this study is to demonstrate the appropriate level of fixation by comparing the results of short-segment and long-segment posterior fixation. SUMMARY OF LITERATURE REVIEW: There is general consensus that short-segment fixation should be done in thoracolumbar burst fractures that are 6 points or less in load-sharing classification. There is some controversy regarding whether short-segment or long-segment fixation should be done in thoracolumbar burst fractures that are 7 points or above in load-sharing classification.
MATERIALS AND METHODS
From 1998 through 2008, 32 patients with thoracolumbar burst fractures above 7 points in load-sharing classification had been operated with short-segment (1 segment above and 1 segment below: 23 patients) or long-segment (2 segments above and 1 segment below: 9 patients) transpedicular screw fixation at the author's institution. They were divided by two groups (group I: short-segment fixation, group II: long-segment fixation). The mean age of patients was 49.2 years old and the mean follow-up period was 2.4 years (1-7 years). In preoperative and postoperative simple radiographs, the bony unions, breakages or loosening of implants were assessed, and the losses of correction angle and anterior vertebral body height were measured.
RESULTS
In all cases, non-union or loosening of implants were not observed. There was 1 screw breakage in short-segment fixation group during the follow up period, but bony union was obtained at final follow-up. The mean score of load sharing classification was 7.3 in Group I and 7.1 in Group II, and there was no significant difference between two groups. (p>0.05) The mean anterior vertebral body height loss was 5.3% in Group I and 3.6% in Group II and the mean loss of correction angle were 4.72 in Group I and 3.38 in Group II. There was no significant difference between the two groups for both. (p>0.05)
CONCLUSIONS
There was no significant difference in radiologic parameters between two groups. Short-segment fixation could be used successfully in selected cases of thoracolumbar burst fractures that are 7 points or above in load-sharing classification.

Keyword

Thoracolumbar; Burst fracture; Short segment posterior fixation; Posterior fusion; Load sharing classification

MeSH Terms

Body Height
Consensus
Follow-Up Studies
Humans
Retrospective Studies

Figure

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  Fig. 1. (A) 37-year-old woman, L1 burst fracture, load sharing score is 7. (B) Short segment transpedicular fixation was done from T12 to L2. (C) Axial CT image shows comminution, canal encroachment. (D) Followup X-ray at 6 years shows minimal loss of correction.

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  Fig. 2. (A) 52-year-old man, L1 burst fracture, load sharing score is 7. (B) Long segment transpedicular fixation was done from T11 to L2. (C) Axial CT image shows comminution, canal encroachment. (D) Followup X-ray at 2 years shows minimal loss of correction.

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