• Vol. 43 No. 1, 24–32
  • 15 January 2014

Surgical Outcome in Thoracolumbar Fractures Managed by Short-segment Pedicle Instrumentation

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ABSTRACT

Introduction: This study aims to evaluate the efficiency of short-segment instrumentation in treating thoracolumbar fractures in our institute.

Materials and Methods: Twenty-two patients underwent posterior short-segment instrumentation for thoracolumbar fractures in our institute from 2007 to 2010 were included in this retrospective study. Radiological evaluations were carried out by measuring regional kyphosis angle (RA), anterior vertebral body compression percentage (AVC), and sagittal index (SI) during preoperative, postoperative and final follow-up, with the aim to investigate the rate of correction loss and implantation failure in relation to the Arbeitsgemeinschaft für Osteosythese(AO) classification of fracture system and the Load Sharing score system. CT scans were also used to determine the preoperative to postoperative canal compromise ratio. During the final follow-up, clinical outcomes were analysed based on scores from the Denis’ Pain’s and Work scales and neurological function was scored according to the Frankel classification.

Results: At the final follow-up (average duration of 15 months), 21 patients (95%) who partially or fully recovered from thoracolumbar fractures were able to resume daily activities with no complaints of pain, or only slight pain. No deterioration in neurological function were recorded. Upon evaluation at each point of time, (preoperative, postoperative and final follow-up), the average RA improved from 21º to 3.5 º to 5.6º, average AVC improved from 40.8% to 90.2% to 88.2%, and average SI changed from 19.1º to 3.1º to 4.1º, respectively. Average canal compromise ratio decreased from 45% to 6.7% after surgery. No correlation was found between loss of correction and AO classification of fracture system, and loss of correction and Load Sharing system scores. Also, no correlation was found between clinical outcomes and the correction loss limited to 10º.

Conclusion: Posterior short-segment fixation in thoracolumbar fractures showed a satisfactory outcome in 95% of the patients based on a 15-month follow-up in our institute, even among patients with comminuted fractures injuries.


Thoracolumbar junction vertebrae are particularly vulnerable in traumatic injuries and up to 90% of all spinal fractures occur in this area. Treatment of thoracolumbar fractures has been a controversial subject for many years. Non-operative management recommended by some authors is effective when there is no evidence of neural compression or spinal instability. However, operative intervention should be seriously considered when a fracture is complicated by progressive neurological deficiency or in situations like neural element compression, fracture dislocation or progressive symptomatic kyphosis. The goals of surgical treatment of thoracolumbar fractures are to restore vertebral column stability, decompress the neural tissue, facilitate neurological recovery, and prevent loss of correction with neurological impairment. Different surgical strategies and treatment methodologies were developed in past decades, but no one single method is clearly better than the rest, making it difficult to determine the optimal treatment strategy. Orthopaedic surgeons should consider the efficiency and advantages of different fracture segment fixation approaches (anterior, posterior), fixation ranges (short-, intermediate- or long-segment fixation), and whether or not bone grafting is necessary. An anterior approach can provide excellent visualisation for decompression of neural elements and easy access for reconstruction of the anterior column with a load-sharing construct. However, an anterior approach may be more technically demanding for obtaining a clear exposure, and thorough neural decompression, which can increase morbidity and potential vascular injuries. On the other hand, a posterior approach is technically less challenging. As a result, this approach is recommended by majority of the spinal surgeons as the choice of treatment for unstable thoracolumbar injuries.

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