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Intermediate screws or kyphoplasty: Which method of posterior short-segment fixation is better for treating single-level thoracolumbar burst fractures?

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Abstract

Purpose

To compare intermediate screws (IS) with kyphoplasty (KP) in posterior short-segment fixation (PSSF) for patients with single-level thoracolumbar burst fractures.

Methods

Between 2010 and 2016, 1465 patients were retrospectively reviewed; 48 patients were enrolled with a minimal follow-up of 2 years. Perioperative and functional outcomes were compared. The regional Cobb angle (CA) was included in radiographic analysis. Implant failures or CA correction loss over 10° were regarded as surgical failures. Multiple linear regression was performed to investigate the risk factors of kyphosis recurrence.

Results

Fluoroscopic time (23.7 ± 3.6 vs. 79.3 ± 12.1 s, p < 0.001), operative time (109.6 ± 13.1 vs. 123.8 ± 19.0 min, p = 0.006) and blood loss (104.6 ± 34.9 vs. 129.1 ± 21.7 ml, p = 0.005) were all lower in the IS group. The KP group had lower Visual Analogue Scale scores (3.3 ± 0.9 vs. 2.7 ± 0.8, p = 0.028) and greater anterior body height (ABH) (30.3 ± 9.0 vs. 36.3 ± 11.0%, p = 0.044) after surgery, and less correction loss (5.6 ± 2.7 vs. 0.4 ± 1.2%, p < 0.001). Both groups had a CA correction loss of 4° with a 10% failure rate. The A3 Magerl subclassification, smaller preoperative ABH and smaller postoperative CA had positive correlations with CA correction loss.

Conclusion

PSSF with KP provides better back pain relief, greater ABH reduction and less correction loss, while IS has the advantages of less operative time, fluoroscopic time and blood loss. Magerl subclassification of burst fracture is a potential predictor for recurrent kyphosis. Reducing fractured vertebral body height rather than segmental curvature may be more important in PSSF.

Study design

Retrospective, non-randomized controlled study.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Acknowledgements

We would like to acknowledge the invaluable contribution of the patients. Thanks to all patients involved in this study.

Author information

Author notes

  1. Junxin Zhang and Hao Liu have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, No 188, Shizi Street, Suzhou, 215006, Jiangsu, China

    Junxin Zhang, Hao Liu, Fan He, Feng Zhou, Huilin Yang & Tao Liu

  2. Orthopaedic Institute, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

    Junxin Zhang, Hao Liu, Fan He, Feng Zhou, Huilin Yang & Tao Liu

  3. Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

    Hui Liu

  4. Health Study, University of Waterloo, Waterloo, Canada

    Angela Carley Chen

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  1. Junxin Zhang
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Correspondence to Tao Liu.

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Zhang, J., Liu, H., Liu, H. et al. Intermediate screws or kyphoplasty: Which method of posterior short-segment fixation is better for treating single-level thoracolumbar burst fractures?. Eur Spine J 28, 502–510 (2019). https://doi.org/10.1007/s00586-018-5822-7

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