Long-segment fixation VS short-segment fixation combined with kyphoplasty for osteoporotic thoracolumbar burst fracture

Abstract

Background To retrospectively compare clinical and radiological results of long-segment fixation (LF) and six-screw short-segment fixation combined with kyphoplasty (SSFK) for osteoporotic thoracolumbar burst fracture (OTBF). Methods Forty patients affected by OTBF with mean age of 61.85 years were included in this study. The mean follow-up period was 13.63 months. Twenty-four patients were treated by SSFK, and 16 patients were treated by LF. Clinical outcomes, radiological parameters and complications were assessed and compared. Results The mean operative time and blood loss were 89.71 ± 7.62 min and 143.75 ± 42.51 ml for SSFK group, respectively; 111.69 ± 12.25 min (P < 0.01) and 259.38 ± 49.05 ml (P < 0.01) for LF group, respectively. The two groups were similar in terms of preoperative radiological and clinical results. Compared with preoperative values, both groups achieved significant improvement in terms of VAS, ODI, Cobb angle and anterior vertebral body height (AVH) ratio at final follow-up. However, during the follow-up period, significant loss of Cobb angle and AVH ratio were observed for both groups. Five cases (20.83%) of asymptomatic cement leakage were observed in SSFK group. One case of implant failure and two cases of adjacent or non-adjacent vertebral fractures were observed in LF group. Conclusions Both SSFK and LF are safe and effective for treatment of OTBF. Comparatively, SSFK is less invasive and can preserve more motion segments, which may be a more valuable surgical option in some elderly patients. A high-quality randomized controlled study is required to confirm our finding in the future.

Full Endoscopic Paramedian Partial Lumbar Corpectomy for a Lumbar Burst Fracture With Spinal Canal and Foraminal Stenosis: A Case Report With a Technical Note

“…Although stand-alone vertebroplasty in thoracolumbar trauma is controversial, combining it with PSF has shown promise in restoring vertebral body height, supporting the anterior column, and preventing correction loss and implant failure [12,13]. This combination allows for short-segment fixation instead of long-segment fixation, which preserves more motion segments and is particularly valuable for certain elderly patients [14].…”

Cross-link augmentation enhances CFR-PEEK short fixation in lumbar metastasis stabilization

“…Previous characterizations of short fixations with metallic cross-links (Wahba et al, 2009;Cornaz et al, 2022) represented valid starting points, but could not be considered conclusive and rigorously transferred in spinal oncologic surgery due to the different materials used and the different conditions of the spine itself. Secondly, existing literature on CFR-PEEK instrumentation has focused so far on comparing their performance with metallic ones (i.e., titanium alloys) and agree on its promising responses; however, there is still a lack of systematic evaluation of different CFR-PEEK long and short stabilizations as has been largely done for metallic alloys in the ambit of thoracolumbar fractures (McLain, 2006;Aly, 2017;Li and Liu, 2017;de Andrada Pereira et al, 2021;Lai et al, 2022). Adler et al (2019) and Moon et al (2009) combined the posterior decompression with an L1 corpectomy and surgical vertebral body replacement.…”

Effectiveness of the Endplate Reduction Technique Combined With Bone Grafting for the Treatment of Thoracolumbar Fractures by Using Posterior Short-Segment Fixation

“…22 In contrast, the use of bone cement implants to fill the cavity, has the potential for leakage of the bone cement into the intervertebral disc, muscle block, and venous system, with adverse consequences, 39 though beneficial for filling the residual cavity after reduction and for maintenance of EPR. 9 Bone cement is also difficult to absorb within the vertebral body and prolonged retention within the vertebral body can have a detrimental effect on adjacent vertebrae and discs. 26,40 The risk of implant breakage was lower in the EPR group than in the IS group (0% vs. 9.2%, p = 0.04).…”

“…7 Short-segment fixation is simple, less invasive, and more reliable. [8][9][10] However, since the anterior column of the thoracolumbar instability fracture is severely damaged, the use of short-segment fixation causes concentrated stress, thus easily resulting in failure of reduction and implant breakage, resulting in surgical failure. Furthermore, the posterior short-segment fixation technique refers to an indirect repositioning technique that does not effectively restore the height of the anterior column of the vertebral body due to poor repositioning of the central endplate collapse.…”