Short-Segment Versus Long-Segment Stabilization in Thoracolumbar Burst Fracture: A Review of the Literature

Abstract

Background: Thoracolumbar fractures are the most common traumatic fractures of the spinal column. They result from a compression load without the associated shear, rotational, or translational components. Although neurological compression and spine instability are the recognized indications for surgery, it is unclear which approach should be used to stabilize the spine. Short-segment (SS) stabilization involves the upper and lower levels of the fractured vertebra, while use of more extended instrumentations is defined as long-segment (LS) stabilization. The SS stabilization is the most common approach; nevertheless, its superiority to LS stabilization is not clear yet. Objectives: The aim of the present study was to conduct a review of the literature to find evidence supporting SS or LS posterior stabilization. Methods: A review of the English literature was conducted to select prospective, randomized studies, comparing the effectiveness of stabilization with short and long pedicle screws for thoracolumbar burst fractures in adults. Results: Three studies were selected, including a total of 89 patients. Overall, 40 patients were treated with SS stabilization and 49 with LS stabilization. No significant difference was found between the groups in terms of preoperative and postoperative parameters, as the level of correction was quite similar. However, the measured parameters were significantly different in the follow-up, indicating a major loss of correction in the SS stabilization group. Conclusions: Based on small-scale studies, a major loss of correction is associated with posterior SS stabilization. However, larger studies are needed to confirm this finding and to verify differences in the clinical outcomes.

Keywords

• Short Instrumentation
• Long Instrumentation
• Stabilization
• Burst Fracture
• Adjacent Segment Disease