Outcomes of Thoracolumbar Fracture-Dislocation Managed by Short-Segment and Long-Segment Posterior Fixation: A Single-Center Retrospective Study

Abstract

Background: Long-segment posterior fixation has been used as a mainstay treatment of spine fracturedislocations. Studies using short-segment posterior fixation in cases of thoracolumbar fracture-dislocation are limited. We describe our experience of 26 patients with thoracolumbar fracture-dislocation treated by short-segment or longsegment posterior spinal fixation and fusion.Methods: This is a single-center retrospective study of 26 patients with thoracolumbar fracture-dislocation treated by long-segment (group 1, n ¼ 12) and short-segment posterior instrumentation (group 2, n ¼ 14). Clinical (visual analog scale [VAS], Oswestry Disability Index [ODI]), neurological (American Spinal Injury Association [ASIA] scale), radiological (kyphotic angle, translational percentage, and displacement angle), and surgical (blood loss, operative time) outcomes and complications were recorded with each method. The mean follow-up period was 8.64 months (6-20 months).Results: The mean duration of surgery was 3.92 6 0.67 hours in group 1 and 3.21 6 0.54 hours in group 2, and mean blood loss was 583.33 6 111.5 mL and 478.6 6112.2 mL in groups 1 and 2, respectively (P , .05). There was no radiologically visible pseudarthrosis, implant failure, or screw breakage in either group at follow up with no statistically significant difference between the 2 groups with regard to the radiological outcome (P . .05). Two patients in group 1 and 6 patients in group 2 improved after surgery at least 1 ASIA grade. VAS and ODI improved in both groups at the final follow up.Conclusions: Short-segment fixation can be used for treating fracture-dislocation patients, as it results in less blood loss, decreased intraoperative time, and saves fusion segments with similar radiological and clinical outcomes as longsegment fixation.

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“…Therefore spinal surgery had to postpone until the patient fully recovered from the laparotomy. But there was no difference is reported in decompression and neurological outcome between the anterior and posterior approach, but the posterior approach is superior in less blood loss and operative time [13] .…”

“…The surgical approaches to the fracture-dislocation can be an anterior, combined anterior and posterior, or posterior [13] . Better canal decompression, easy access to the anterior column, and intervertebral fixation are the advantages of the anterior approach.…”

“…Better canal decompression, easy access to the anterior column, and intervertebral fixation are the advantages of the anterior approach. But it will not provide sufficient traction for fracture reduction [13] . The combined anterior and posterior approach improves sagittal alignment, Better neural decompression.…”

“…The combined anterior and posterior approach improves sagittal alignment, Better neural decompression. But It is associated with more intraoperative bleeding and extended surgery time and the need to change the position during surgery [13] . Because of the previous abdominal surgery, the only option for vertebral decompression was the posterior approach.…”

“…Fixation could be a long segment or short segment fixation [13] . In this case, long-segment fixation was used because Long segment posterior fixation is with two levels above and two levels below fixation considered for highly unstable spinal injuries to achieve multiple fixation points and distribute the stress while maintaining alignment [2] , [13] . Short segment fixation can also be used for thoracolumbar fracture dislocation as it causes less blood loss and fewer operative duration [13] .…”