Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;16(5):772-778.
doi: 10.14444/8337. Epub 2022 Aug 17.

Unstable Thoracolumbar Injuries: Factors Affecting the Decision for Short-Segment vs Long-Segment Posterior Fixation

Juan P Cabrera  1   2 , Alfredo Guiroy  3 , Charles A Carazzo  4 , Ratko Yurac  5   6 , Marcelo Valacco  7 , Emiliano Vialle  8 , Andrei F Joaquim  9 ; AO Spine Latin America Trauma Study Group
Affiliations

Unstable Thoracolumbar Injuries: Factors Affecting the Decision for Short-Segment vs Long-Segment Posterior Fixation

Juan P Cabrera et al. Int J Spine Surg. 2022 Aug.

Abstract

Background: Factors influencing the length of spinal instrumentation have been mostly evaluated in burst fractures, receiving more attention than other unstable thoracolumbar injuries. We aimed to evaluate clinical factors affecting surgical decision-making and associated complications.

Methods: This was a multicentric retrospective cohort study. Outcomes of patients with AO Spine injury classification types B2, B3, and C operated through an open posterior-only approach were analyzed. Length of instrumentation was correlated with age, type of injury, comorbidities, level of injury, neurological status, and complications.

Results: Among 439 patients, 30.3% underwent short-segment fixation (SSF) and 69.7% underwent long-segment fixation (LSF). Type C injuries were treated with LSF in 89.4% of cases (P < 0.001). On multivariate analysis, age ≤39 years (OR: 2.06), AO spine type B2 (OR: 3.58), and type B3 (OR: 7.48) were statistically significant predictors for SSF, while hypertension (OR: 4.07), upper thoracic injury (OR: 9.48), midthoracic injury (OR: 6.06), and American Spinal Injury Association Impairment Scale A (OR: 3.14) were significantly associated with LSF. Patients with SSF had fewer overall complications (27.1% vs 50.9%, P < 0.001) and were less likely to develop pneumonia (6.0% vs 18.3%, P < 0.001) and urinary tract infections (6.8% vs 16.3%, P < 0.007).

Conclusions: Unstable thoracolumbar injuries were mostly treated by LSF. Length of instrumentation was affected by the type of spinal injury, location of the injury, and neurological status. SSF was associated with lower rates of early complications than LSF.

Clinical relevance: The decision on the length of fixation in the surgical treatment of unstable thoracolumbar injuries is affected by different factors, and it will impact the rate of postoperative complications.

Keywords: multivariate analysis; pedicle screws; postoperative complications; spinal fusion; spinal injuries.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The authors report no conflicts of interest in this work.

Figures

Figure
Figure
Distribution of patients receiving short-segment fixation (SSF) or long-segment fixation (LSF) according to the level of injury.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Hager S, Eberbach H, Lefering R, et al. . Possible advantages of early stabilization of spinal fractures in multiply injured patients with leading thoracic trauma - analysis based on the traumaregister DGU®. Scand J Trauma Resusc Emerg Med. 2020;28(1):42. 10.1186/s13049-020-00737-6 - DOI - PMC - PubMed
    1. Vaccaro AR, Oner C, Kepler CK, et al. . AOSpine thoracolumbar spine injury classification system. SPINE. 2013;38(23):2028–2037. 10.1097/BRS.0b013e3182a8a381 - DOI - PubMed
    1. Guiroy A, Carazzo CA, Zamorano JJ, et al. . Time to surgery for unstable thoracolumbar fractures in latin America-A multicentric study. World Neurosurg. 2021;148:e488–e494. 10.1016/j.wneu.2021.01.010 - DOI - PubMed
    1. Sousa A, Rodrigues C, Barros L, Serrano P, Rodrigues-Pinto R. Early versus late spine surgery in severely injured patients-which is the appropriate timing for surgery? Global Spine J. 2021:2192568221989292. 10.1177/2192568221989292 - DOI - PMC - PubMed
    1. Ter Wengel PV, De Haan Y, Feller RE, Oner FC, Vandertop WP. Complete traumatic spinal cord injury: current insights regarding timing of surgery and level of injury. Global Spine J. 2020;10(3):324–331. 10.1177/2192568219844990 - DOI - PMC - PubMed

LinkOut - more resources