Thoracolumbar fractures: Factors predicting failure of percutaneous short- and long-segment posterior fixation

Introduction

Thoracolumbar (TL) transition trauma is frequent and challenging. Although short- (SSPF) and long-segment posterior fixation (LSPF) are its mainstay treatment, little is known about their failure rates and reasons behind it.

Research question

understand why TL instrumentations fail and what factors influence it.

Materials and methods

Retrospective, cohort, unicentric analysis on adult patients with acute TL trauma treated with percutaneous transpedicular SSPF or LSPF. Two groups were created, according to the presence of treatment failure at follow-up. We analyzed whether age ≥65 years old, fracture segment, posterior ligamentous complex (PLC) injury, load sharing classification (LSC) score >6, type of instrumentation (SSPF vs LSPF) and abnormal bone mineral density (BMD) were associated with failure. To achieve this, we evaluated radiological parameters at the preoperative, postoperative and follow-up appointments.

Results

87 patients were included: 60 (69.0%) without failure and 27 (31.0%) with. Age ≥65 years old (aOR = 3.66, p = 0.020), PLC injury (aOR = 2.94, p = 0.048) and SSPF (aOR = 6.75, p = 0.013) were statistically significant factors contributing to failure. The first two also presented shorter times to failure (35.2 vs 69.1 months, p = 0.013, and 25.2 vs 69.1 months, p = 0.037, respectively). In PLC injured patients, there was no statistically significant difference between SSPF vs LSPF.

Discussion and conclusions

We conclude that age >65 years old, PLC injury and SSPF may be correlated with instrumentation failure. The first two factors were also associated with a shorter time to failure.