Egyptian Spine Journal (Jan 2013)
Comparison of long segment fixation versus short segment fixation with pedicle screws at the level of the fracture in the management of Thoracolumbar fractures
Abstract
Background Data: long segment fixation have been frequently used for management of thoracolumber burst fractures of the spine. Concerns about lost motion segment with this type of fixation made the suggestion for a shorter fixation method. Purpose: To assess ability of short segment pedicle screw fixation to correct deformity, maintain correction and prevent failure in comparison to the traditional long segment fixation. Study Design: A comparative clinical case study. Patients and Methods: A total of 46 patients presented with thoracolumbar burst fractures between 2008 and 2012. All cases were operated with posterior fixation and instrumentation. We classified patients into 2 groups, Group A were operated with long segment pedicle screw fixation, and Group B operated with short segment pedicle screw fixation including the fractured level. Fusion was done in all cases using spinous process and laminectomy bone. Results: The study included 5 (10.9%) females and 41 (89.1%) males. Their age ranged from 24 to 64 years (mean 40 years). Group A (Long segment fixation) included 28 (60.9%) patients and group B (Short segment fixation) included 18 (39.1%) patients. No statistical significance was found between the choice of fixation method and the following parameters: preoperative kyphotic angle, postoperative kyphotic angle (immediate), postoperative kyphotic angle (last follow up), postoperative angle change (immediate) and postoperative angle change (last follow up). We assessed the amount of correction loss in relation to the initial degree of kyphosis correction. A statistically significant relationship could be found between the amount of initial kyphosis correction and amount of correction loss. It has been reported that a greater amount of initial kyphosis angle correction was associated with a lesser amount of correction loss. The implant failure rate was recognized in 5 patients (10.9%). Four of these cases were of the short segment category and one of the long segment category. Conclusion: Short segment fixation using pedicle screw at the level of fracture, in the thoracolumbar burst fractures; provides comparable correction to long segment fixation. Correction loss can be minimized by proper selection of cases suitable forshort segment fixation. Short segment fixation should be reserved to cases with mild to moderate degrees of initial kyphosis. (2013ESJ041)
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