Long versus Short Segment Instrumentation in Osteoporotic Thoracolumbar Vertebral Fracture

Abstract

This study aimed to compare clinical and radiological data and rate of mechanical complications in elderly patients treated with short segment (SSS) or long segment stabilization (LSS) for thoracolumbar junction osteoporotic vertebral fractures (OVFs). Overview of Literature: A fervent debate is now focused on the treatment of OVF using SSS or LSS. High rate of complications is associated with pedicle screw fixation because of poor bone quality. Methods: Patients over 65 years old with a T-score of <−2.5, affected by (T10-L2) vertebral fracture treated with LSS or SSS pedicle screw fixation, with at least 24 months of follow-up were evaluated. All patients were analyzed with conventional X-ray to evaluate bisegmental kyphotic angle (BKA) and clinically with Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and rate of mechanical complications at 2, 6, 12, and 24 months. Data were expressed as mean±standard deviation. Student t-test was used to compare clinical scores between populations. Mann-Whitney U-test was used to analyze clinical and radiological variable, whereas Fisher's exact test was used to identify differences in the rate of complications between groups. Results: A total of 37 patients met the inclusion criteria. Mean follow-up was 33.97±9.26 months. For both groups, ODI and VAS significantly decreased over time with good results (p<0.00001). At the final follow-up, no significant differences were found in terms of ODI and VAS. There was no difference in correction of BKA between groups; however, a significant difference was found in LSS group between pre-and postoperative BKA (p=0.046), whereas no difference was found in SSS group. A significant difference in the rate of mechanical complications was found between groups (p=0.011). Conclusions: Both treatments showed good clinical and radiological results; however, LSS group showed better BKA correction and lower mechanical complications than SSS group.

Long-segment Fixation VS Short-segment Fixation Combined With Kyphoplasty for Osteoporotic Thoracolumbar Burst Fracture

“…Further, most spine surgeons are more familiar with posterior approach. In biomechanically, LF with two or more levels above and below the fracture is a better choice for thoracolumbar burst fracture, which can provide greater mechanical stiffness and reduce likelihood of segmental collapse and implant failure [4,17]. However, except disruption of spinal motion segments, LF is correlated with more severe surgical invasiveness.…”

“…Schulze et al [21] reported signi cant migration of pedicle screws following xation of osteoporotic vertebrae placed under exion/extension cyclic loading, and the anchoring effect holding the screw in place was decreased in osteoporotic cases. Although intermediate pedicle screws were used in the fractured vertebra, signi cant kyphotic correction loss and mechanical failure were observed in cases with osteoporotic thoracolumbar fracture [4]. In addition, the intravertebral area of osteoporotic burst fracture enlarged by positional or instrumental reduction is nearly empty, and such insu cient anterior column support may not endure vertical physiological strength with stand-alone posterior pedicle construct, even LF construct was used [22,23].…”

“…However, these surgeries are fraught with complication due to debilitated state of elderly patients [2,3]. When posterior approach is performed, controversy exists regarding the use of xation by short or long-segment pedicle screws [4]. Posterior six-screw short-segment pedicle instrumentation (include the fractured vertebra) is recommended by some surgeons for the treatment of thoracolumbar burst fracture, in order to reduce surgical invasiveness, enhance biomechanical stability and minimize the number of xation segments [5].…”

Response to: Long versus Short Segment Instrumentation in Osteoporotic Thoracolumbar Vertebral Fracture

“…We thank the Author for their interest in our manuscript [ 1 ], and we would like to reply to their comments:…”

Letter to the Editor: Long versus Short Segment Instrumentation in Osteoporotic Thoracolumbar Vertebral Fracture

“…We have read the article by Girardo et al [ 1 ] entitled “Long versus short segment instrumentation in osteoporotic thoracolumbar vertebral fracture” with great interest and congratulate the authors for this thought-provoking topic of interest; however, there are few pertinent queries that need to be addressed:…”