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Treatment of unstable thoracolumbar junction fractures: short-segment pedicle fixation with inclusion of the fracture level versus long-segment instrumentation

  • Clinical Article - Spine
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Abstract

Background

The surgical management of thoracolumbar burst fractures frequently involves posterior pedicle screw fixation. However, the application of short- or long-segment instrumentation is still controversial. The aim of this study was to compare the outcome of the short-segment fixation with inclusion of the fracture level (SSFIFL) versus the traditional long-segment fixation (LSF) for the treatment of unstable thoracolumbar junction fractures.

Methods

From December 2009 to February 2014, 60 patients with unstable thoracolumbar junction fractures (T11-L2) were divided into two groups according to the number of instrumented levels. Group 1 included 30 patients treated by SSFIFL (six-screw construct including the fracture level). Group 2 included 30 patients treated by LSF (eight-screw construct excluding the fracture level). Local kyphosis angle (LKA), anterior body height (ABH), posterior body height (PBH), ABH/PBH ratio of fractured vertebra, and Asia Scale Impairment Scale were evaluated.

Results

The two groups were similar in regard to age, sex, trauma etiology, fracture level, fracture type, neurologic status, pre-operative LKA, ABH, PBH, and ABH/PBH ratio and follow-up (p > 0.05). Reduction of post-traumatic kyphosis (assessed with LKA) and restoration of fracture-induced wedge shape of the vertebral body (assessed with ABH, PBH, and ABH/PBH ratio) at post-operative period were not significantly different between group 1 and group 2 (p = 0.234; p = 0.754). There was no significant difference between the two groups in term of correction loss at the last follow-up too (LKA was 15.97° ± 5.62° for SSFIFL and 17.76° ± 11.22° for LSF [p = 0.427]). Neurological outcome was similar in both groups.

Conclusions

Inclusion of fracture level in a short-segment fixation for a thoracolumbar junction fractures results in a kyphosis correction and in a maintenance of the sagittal alignment similar to a long-segment instrumentation. Finally, this technique allowed us to save two or more segments of vertebral motion.

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Authors and Affiliations

  1. Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Via Conca #71, Ancona, 60020, Italy

    Mauro Dobran, Davide Nasi, Denise Brunozzi, Lucia di Somma, Maurizio Gladi, Maurizio Iacoangeli & Massimo Scerrati

Authors
  1. Mauro Dobran
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  2. Davide Nasi
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  3. Denise Brunozzi
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  4. Lucia di Somma
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  5. Maurizio Gladi
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  6. Maurizio Iacoangeli
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  7. Massimo Scerrati
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Corresponding author

Correspondence to Davide Nasi.

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No funding was received for this research.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Dobran, M., Nasi, D., Brunozzi, D. et al. Treatment of unstable thoracolumbar junction fractures: short-segment pedicle fixation with inclusion of the fracture level versus long-segment instrumentation. Acta Neurochir 158, 1883–1889 (2016). https://doi.org/10.1007/s00701-016-2907-0

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  • DOI: https://doi.org/10.1007/s00701-016-2907-0

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