Comparison of Four Different Posterior Screw Fixation Techniques for the Treatment of Thoracolumbar Junction Fractures

Abstract

Objective: The purpose of this study was to compare clinical and radiologic outcomes of patients who underwent short-segment posterior instrumentation with screw augmentation at the fracture level and long-segment instrumentation for thoracolumbar junction fractures.

Methods: Sixty-three patients were retrospectively evaluated by being divided into the following 4 groups: Groups A, B, C, and D included patients who had undergone 4-level instrumentation without insertion of screws at the fracture level, 3-level instrumentation by insertion of screws at the fracture level, 4-level instrumentation by insertion of screws at the fracture level, and 5-level instrumentation by insertion of screws at the fracture level, respectively.

Results: No significant difference was observed in preoperative local kyphosis angle (LKA) (P > 0.05), whereas there was a significant decrease in early postoperative LKA in Group C compared with the other groups (P < 0.05). However, there was no significant difference of LKA in the 4 groups measured on radiographs obtained at the final follow-up (P > 0.05). Anterior corpus height loss, Cobb angle of the fractured vertebra, and sagittal index, measured pre- and postoperatively and at the final follow-up, showed no significant difference (P > 0.05). There was no statistically significant difference between clinical scores of the 4 groups (P > 0.05).

Conclusions: Short-segment posterior instrumentation with screw augmentation at the fracture level provides at least as much mechanical stability as long-segment instrumentation. Moreover, there is no difference between short-segment instrumentation with screw augmentation at the fracture level and long-segment instrumentation in terms of clinical outcomes.

Keywords: Fracture; Posterior stabilization; Short segment instrumentation; Thoracolumbar junction.