Comparison of Posterior Fixation Alone and Supplementation with Posterolateral Fusion in Thoracolumbar Burst Fractures

Abstract

ObjectiveWe compared the radiological and clinical outcomes between patients who underwent posterior fixation alone and supplemented with fusion following the onset of thoracolumbar burst fractures. In addition, we also evaluated the necessity of posterolateral fusion for patients treated with posterior pedicle screw fixation.MethodsFrom January 2007 to December 2009, 46 consecutive patients with thoracolumbar burst fracture were included in this study. On the basis of posterolateral fusion, we divided our patients into the non-fusion group and the fusion group. The radiological assessment was performed according to the Cobb's method, and results were obtained at immediately, 3, 6, 12 months after surgery. The clinical outcomes were evaluated using the modified Mcnab criteria at the final follow-up.ResultsThe demographic data and the mean follow-up period were similar between the two groups. Patients of both groups achieved satisfactory clinical outcomes. The mean loss of kyphosis correction showed that patients of both groups experienced loss of correction with no respect to whether they underwent the posterolateral fusion. There was no significant difference in the degree of loss of correction at any time points of the follow-up between the two groups. In addition, we also compared the effect of fixed levels (i.e., short versus long segment) on loss of correction between the two groups and there was no significant difference. There were no major complications postoperatively and during follow-up period.ConclusionWe suggest that posterolateral fusion may be unnecessary for patients with thoracolumbar burst fractures who underwent posterior pedicle screw fixation.

Two additional augmenting screws with posterior short-segment instrumentation without fusion for unstable thoracolumbar burst fracture – Comparisons with transpedicular grafting techniques

“…Hwang et al. reported 15 patients with thoracolumbar burst fractures that underwent posterior short-segment pedicle instrumentation without fusion [18] . These 15 patients also had two augmenting screws at the fractured vertebra; the results showed no implant-related complication and the mean loss of correction angle was 6.1° at the 12-month follow-up.…”

Thoracolumbar spine trauma: Evaluation and surgical decision-making

“…[ 39 ] Confirming the high number of techniques variations, Hwang et al ., 2012, published a series of 46 patients with burst fractures treated surgically with posterior fixation with and without fusion. [ 40 ] They obtained similar results in both groups, suggesting that posterolateral fusion may be unnecessary in the treatment of burst fractures treated by a posterior approach. Even kyphoplasty has been used for treatment of TLST, with some studies suggesting benefits in improvement and maintenance of radiological parameters, such as body height and local kyphosis, although these advantages are not clearly correlated to patient's outcome.…”

Effect of manual reduction and indirect decompression on thoracolumbar burst fracture: a comparison study

“…CT scan can find that the bone cortex of the posterior edge of the vertebral body is not connected, and the bone block is slightly displaced [ 14 ]. Therefore, the main difference between compression fracture and burst fracture is whether the central column is involved [ 15 ]. With the increase of vertical compression force, the vertebral body changes from a compression fracture to a burst fracture.…”