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Corresponding Author

Nagaty, Ahmed

Subject Area

Trauma

Article Type

Original Study

Abstract

Background Data: Application of either long- or short-segment instrumentation with intermediate screw to correct thoracolumbar spine fracture is still controversial. Both surgical techniques have their advantages and disadvantages. Even though early clinical results of these surgeries are usually satisfactory, a high failure rate and progressive kyphosis remain a concern. Purpose: To assess the efficiency and safety of short-segment pedicle screw fixation in thoracolumbar junction fracture with an intermediate screw placement compared to the more popular long-segment technique. Study Design: A retrospective comparative study Patients and Methods: A total of 61 patients were reported in this study and divided into two groups: Group I (33 patients) in which patients were surgically treated by short-segment instrumentation with intermediate screw placement at the fractured level and Group II in which all patients were surgically treated using long-segment instrumentation excluding the fracture level (28 patients). Outcome parameters included Visual Analogue Score (VAS) score of back pain and American Spinal Injury Association (ASIA) score of neurological status. Results: Although the VAS of back pain rapidly improved in Group I compared to Group II during the one-year follow-up, both had the same end results with no significant difference between both groups (P > 0.05). In Group I, the preoperative Cobb’s angle was 19.3 ± 3.7, which was corrected in the immediate postoperative X-ray to 6.8 ± 2.6 and maintained on the final follow-up at one year at 7.97 ± 1.67. In Group II, the mean preoperative Cobb’s angle was 18.7 ± 3.8, which was corrected in the immediate postoperative X-ray to 5.8 ± 1.6 and maintained on the final follow-up at one year at 7.89 ± 1.67. However, there was no statistically significant difference between both groups regarding angle correction (P > 0.05). In perioperative data, Group I showed less operative time (137.73 ± 16.96) than Group II (153.57 ± 19.525) with a highly significant statistical difference (P < 0.001). In addition, there was a significant statistical difference (P < 0.05) regarding intraoperative blood loss, as Group I (270.45 ± 35.363) showed less blood loss than Group II (292.5 ± 34.788). Conclusion: Short-segment instrumentation with intermediate pedicle screws at the fractured level is an effective method for treating thoracolumbar junction fractures with clinical and radiological outcomes similar to those of long-segment instrumentation but with less operative time and blood loss. However, a multicenter study with long-term follow-up is highly recommended. (2021ESJ238)

Keywords

short-segment, Intermediate Screw, thoracolumbar fractures, Trauma, spine

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