Is Fusion Necessary for Surgically Treated Burst Fractures of the Thoracolumbar and Lumbar Spine?

Abstract

The short-term results of short segmental fixation without fusion for surgically treated burst fractures of the thoracolumbar spine were satisfactory. The advantages of instrumentation without fusion are the elimination of donor site complications, saving more motion segments, and reducing blood loss and operative time.

Operative Treatment of Thoracolumbar Burst Fractures: Is Fusion Necessary?

“…The results of this study are largely consistent with what has been reported in the literature, as well as previous studies by the investigators [6]. Good functional outcomes following posterior fixation for burst fractures without fusion have been reported in the literature, as measured by VAS, low-back outcome score, or the SF-36 [3,4].…”

“…There have been several prospective trials comparing patients treated with posterior short segment instrumentation for thoracolumbar and lumbar burst fractures, randomized to fusion or no fusion, with largely similar outcomes [1,6].…”

Pure percutaneous pedicle screw fixation without arthrodesis of 32 thoraco-lumbar fractures: clinical and radiological outcome with 36-month follow-up

“…The advantages of non fusion are several including elimination of donor site complications [22], sparing more motion segments, reduction of operative time during the surgery, of blood loss as well as reduced risks of infections, which is crucial in case of multi trauma or severely injured patients with multi organ posttraumatic failure syndrome [6].…”

“…Different authors who evaluated the loss of correction in the non fusion group (MISS) found no statistical evidence between the two groups (open vs. MISS) [6] and also stated that posterior fusion is unnecessary when managing patients with thoraco-lumbar burst fractures by short segment pedicle screw fixation [7].…”

“…Additional pedicle screws, so-called ''lordorizing screw'', could provide an anterior force once either the rod is simply fixed to the screws or the system undergo distraction, which pushes the injured vertebra ventrally and correct the kyphotic deformity up to succeed in restoring the physiological lordosis [6].…”