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European Spine Journal

, Volume 28, Issue 3, pp 502–510 | Cite as

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

  • Junxin Zhang
  • Hao Liu
  • Hui Liu
  • Angela Carley Chen
  • Fan He
  • Feng Zhou
  • Huilin Yang
  • Tao LiuEmail author
Original Article

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.

Keywords

Single-level Thoracolumbar burst fracture Posterior short-segment fixation Intermediate screws Kyphoplasty 

Notes

Acknowledgements

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

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

586_2018_5822_MOESM1_ESM.doc (38 kb)
Supplementary material 1 A flowchart showing how patients were included or excluded for this study
586_2018_5822_MOESM2_ESM.pptx (140 kb)
Supplementary material 2 (PPTX 139 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
  2. 2.Orthopaedic InstituteThe First Affiliated Hospital of Soochow UniversitySuzhouChina
  3. 3.Department of OncologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina
  4. 4.Health StudyUniversity of WaterlooWaterlooCanada

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