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Short Versus Long Segment Pedicle Screw Fixation Outcome in Thoracolumbar Burst Fracture: A Comparative Analysis

Rahul Lamba , Deepak Beniwal1 , Rahul Lamba2 , Prashant Modi3 , Drvijay Yadav4

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Journal of Orthopedic Education 5(3):p 131-140, September-December 2019. | DOI: DOI: http://dx.doi.org/10.21088/joe.2454.7956.5319.2

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Deepak Beniwal, Rahul Lamba, Prashant Modi, et al. Short Versus Long Segment Pedicle Screw Fixation Outcome in Thoracolumbar Burst Fracture: A Comparative Analysis. J Orthop Educ. 2019;5(3):131–140.

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Abstract

Introduction: Thoracolumbar burst fractures, frequently associated with kyphotic deformity and neurological deficit are very common in younger patients and could have a great impact on their daily physical activities. The primary goal of treatment of the thoracolumbar fracture is keeping patients alive, protecting from the further neural damage, obtaining the stability by reconstructing anatomical alignment of spinal columns and returning patients to workplace through early mobilization and rehabilitation. Aim: Comparison between two groups which includes short segment fixation (fracture vertebrae and long segment fixation with pedicle screw). Material and Methods: This Hospital based Prospective Randomized comparative interventional study between two groups in Department of Orthopaedics SMS Medical College and hospital Jaipur from Nov 2016 to Oct 2018. It included 25 cases of acute, traumatic fractures of the thoracolumbar junction (T9- L3) treated with short segment pedicle fixation one level above and one level below the fractured vertebra including at least one pedicle screw in fractured vertebrae and 25 cases are treated with long segment pedicle screw fixation included the instrumentation at least of two vertebrae above and two vertebrae below the fracture. Complete clinical and neurological examination was done. Observations and Results: The surgical management of thoracolumbar burst fractures through posterior approach, the short segment pedicle screws fixation was not significantly different to the long segment pedicle screws fixation in terms of correction of kyphotic deformity improvement of back pain and return to work and also in LS instrumentation prolonged the operative time and increased the amount of blood loss significantly. SFIFL offers significant advantages such as incorporating fewer motion segments in the fusion, shorter operative time and maintenance of the correct sagittal alignment. Partial neurologic deficits have potential for recovery, the amount depending more on the initial deficit and the time elapsed since the initial deficit than the treatment strategy. Serious complications are rare. Conclusion: Short-segment instrumentation using additional screws at the fracture level in thoracolumbar burst fractures is a proper surgical approach for obtaining clinically and radiologically successful results in terms of the kyphosis angle in a maintenance of the sagittal alignment this technique allowed to save two or more segments of vertebral motion, operative time and blood loss as compared to long segment fixation.

Keywords: Thoracolumbar burst fractures; Kyphosis angle, Short segment pedicle screw fixation.

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Deepak Beniwal, Rahul Lamba, Prashant Modi, et al. Short Versus Long Segment Pedicle Screw Fixation Outcome in Thoracolumbar Burst Fracture: A Comparative Analysis. J Orthop Educ. 2019;5(3):131–140.

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DOI: DOI: http://dx.doi.org/10.21088/joe.2454.7956.5319.2

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