Clinical Outcomes of Short Same-segment Fixation in Thoracolumbar Junction Fractures

Abstract

Background: The number of vertebral levels involved in fixing a spine fracture is reduced with short same-segment posterior fixation (SSPF). Short same-segment posterior fixation with pedicle fixation at the fracture level provides biomechanical advantages for kyphosis correction maintenance, lowering failure rates, and increasing spinal motion and early rehabilitation [1-4]. Materials and Methods: Between 2014 and 2016, all patients with thoracolumbar junction fractures in our study were analysed using biomechanical criteria and clinical outcomes. The immediate postoperative radiographs were compared to follow-up radiographs to assess any loss of correction by measuring the kyphotic angle using Cobb's technique. Clinical result was also assessed using the Oswestry disability score at each follow-up. The reliability of the intraobserver and interobserver was investigated. Results: In our study, 35 patients with unstable thoracolumbar fractures were operated on with a posterior spinal fixation system and pedicle screw insertion at the level of the fractured vertebrae during 2014 to 2016. The average time between visits was 18 months. In all of the cases, the average preoperative kyphotic angle was 17.2°, which improved to 5.9° immediately postoperatively, resulting in a mean of 65 percent correction. The average postoperative Cobb's angle was 7.7° at final follow-up, retaining a 55 percent correction. Disability improved from 78% mean preoperatively to 47.27% mean postoperatively at final follow-up. Conclusion: When compared to traditional SSPF, short same-segment posterior fixation has a lower implantation failure rate and improved biomechanical stability; nevertheless, long-term kyphosis correction was not maintained to the same level, which was statistically insignificant. Despite the lack of kyphosis correction, long-term clinical pain and disability improved. This study indicated that SSPF decreases implantation failure rate and reoperation rate and offers greater biomechanical advantages.