Risk factors for failure in short segment pedicle instrumentation in thoracolumbar fractures

Abstract

Introduction

The management of thoracolumbar fractures, particularly through short-segment posterior fixation (SSPF), remains a topic of ongoing debate in spine surgery.

Research question

This study aimed to identify the factors influencing SSPF failure in traumatic thoracolumbar fractures’ treatment, focusing on variables such as age, bone mineral density (BMD), fracture level, posterior ligamentous complex (PLC) injury, screw length, type of screw (monoaxial or polyaxial), instrumentation of the fractured vertebra and sagittal screw angle (SSA).

Material and methods

A total of 66 patients were included, with 43 in the non-failure group (Group N) and 23 in the failure group (Group F). Failure was defined by criteria including screw pull-out, material failure, loss of vertebral height ≥50%, or postoperative kyphosis ≥30°.

Results

The results indicated that age, the use of monoaxial screws and BMD were statistically significant predictors of failure, with older patients (>60 years) showing an eighteen-fold higher risk of failure. Survival analysis revealed that older patients, those with PLC injuries, and those with monoaxial screw instrumentation experienced failure at significantly earlier times.

Discussion and conclusion

These findings suggest that rigorous patient selection, considering factors such as age, BMD, and screw type, is crucial for minimizing the risk of failure in SSPF treatment. Further multicenter prospective studies with larger sample sizes are necessary to validate these results and enhance risk prediction models.