J Korean Soc Spine Surg.  2014 Dec;21(4):139-145. 10.4184/jkss.2014.21.4.139.

The Analysis of the Outcome of Short- and Long-Segment Posterior Instrumentation for Thoracolumbar Bursting Fractures

• Kim WC
• Lee KY
• Wang L
• Lim YH
• Kang JM
• Do HS

• KMID: 2097863
• DOI: http://doi.org/10.4184/jkss.2014.21.4.139

Abstract

STUDY DESIGN: A retrospective study. SUMMARY OF THE LITERATURE REVIEW: The reports comparing short- and long-segment instrumentation are insufficient.
OBJECTIVES
To determine the postoperative results and to analyze relative factors affecting results between short- and long-segment instrumentation in thoracolumbar fractures.
MATERIALS AND METHODS
From March 2006 to March 2012, 97 patients with thoracolumbar fracture were treated with posterior instrumentation. They were divided into 2 groups, the short- (Group I) and long-segment groups (Group II). To analyze factors affecting results, several factors including age, anterior column height (ACH), and the kyphotic angle were reviewed. For radiologic evaluation, postoperative and follow-up radiographs were evaluated by measuring the kyphotic angle and ACH. Additionally, the presence of complications was reviewed.
RESULTS
Groups I and II consisted of 45, 52 cases and had mean ages of 50.3, 55.8 years, respectively. In Group I, the ACH increased from 44.2% to 75.3% postoperatively, and remained 72.8% at follow-up. The kyphotic angle decreased from 19.4degrees to 10.6degrees postoperatively, and remained at 12.8degrees at follow-up. In Group II, the ACH recovered from 41.6% to 76.4% postoperatively, and was 74.8% at follow-up. The kyphotic angle decreased from 21.6degrees to 12.6degrees postoperatively, and was 13.9degrees at follow-up. The canal compromise, age, and comminution were not directly related with results. However, the mean age of the 7 cases showing complications was 72 years, and the 7 cases had severe comminuted fractures.
CONCLUSIONS
The short- and long-segment instrumentations of thoracolumbar fractures are not significantly different with respect to the results attained. However, in order to decrease complications, we should pay attention to age and fracture comminution.

Keyword

Thoraolumbar; Burst fracture; Pedicle screw; Long segment; Short segment

MeSH Terms

Follow-Up Studies
Fractures, Comminuted
Humans
Retrospective Studies

Figure

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  Fig. 1. A 60-year-old female patient with L1 burst fracture treated by short segment pedicle screw fixation. (A) Preoperative X-ray (B) Postoperative X-ray (C) Preoperative CT scan.

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  Fig. 2. A 31-year-old female patient with T12 burst fracture treated by long segment pedicle screw fixation. (A) Preoperative X-ray (B) Postoperative X-ray (C) Preoperative CT scan.

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