Should the Level of the Posterior Instrumentation Combined With the Intermediate Screw Be a Short Segment or a Long Segment in Thoracolumbar Fractures With Fusion to the Fractured Segment?

Abstract

Purpose It was aimed to compare the results of long segment posterior instrumentation with intermadiate pedicular screw + fusion at the level of the fractured segment including one vertebra above and one below the fractured vertebra (LSPI) and short segment posterior instrumentation with intermadiate pedicular screw + fusion at the level of the fractured segment including one vertebra above and one below the fractured vertebra (SSPI) in the surgical treatment of thoracolumbar vertebral fractures.Methods 90 patients with thoracolumbar vertebral (T11-L2) fractures operated between March 2015 and February 2022 were included in the study. The patients were divided into two groups as those who underwent LSPI (group A: n: 54, age: 40.3) and those who underwent SSPI (group B: n: 36, age: 39.7). Radiological evaluations like vertebral compression angle (VCA), vertebral corpus heights (VCH), intraoperative parameters and complications were compared between the groups.Results Correction in early postoperative VCA was statistically significantly better in Group A (p = 0.003). At 1-year follow-up, postoperative VCA correction was significantly more successful in group A (p = 0.001). There was no difference between the two groups in terms of correction loss in VCA measured at 1-year follow-up. There was no statistically significant difference between the two groups in terms of postoperative VCH, VCH at 1-year follow-up, and correction loss in VCH.Conclusion LSPI provides better postoperative kyphosis correction of the fractured vertebra than SSPI. Regarding of the segment level of posterior instrumentation, there was no difference between the two groups in terms of the loss of achieved correction of VCA, ABH, and PBH at 1-year follow-up. Operating a thoracolumbar fracture with LSPI will lengthen the operation and increase the number of intraoperative fluoroscopies compared to SSPI.