The role of fusion in the management of burst fractures of the thoracolumbar spine treated by short segment pedicle screw fixation

Abstract

The purpose of this study was to determine whether patients with a burst fracture of the thoracolumbar spine treated by short segment pedicle screw fixation fared better clinically and radiologically if the affected segment was fused at the same time. A total of 50 patients were enrolled in a prospective study and assigned to one of two groups. After the exclusion of three patients, there were 23 patients in the fusion group and 24 in the non-fusion group. Follow-up was at a mean of 23.9 months (18 to 30). Functional outcome was evaluated using the Greenough Low Back Outcome Score. Neurological function was graded using the American Spinal Injury Association Impairment Scale. Radiological outcome was assessed on the basis of the angle of kyphosis. Peri-operative blood transfusion requirements and duration of surgery were significantly higher in the fusion group (p = 0.029 and p < 0.001, respectively). There were no clinical or radiological differences in outcome between the groups (all outcomes p > 0.05). The results of this study suggest that adjunctive fusion is unnecessary when managing patients with a burst fracture of the thoracolumbar spine with short segment pedicle screw fixation.

Fusion versus Nonfusion for Surgically Treated Thoracolumbar Burst Fractures: A Meta-Analysis

“…No additional studies were obtained after reference review. Finally, four trials including three RCTs and one quasi-RCT were selected and analyzed [15]–[18]. Three RCTs assessed the impact of fusion as a supplement to short-segment fixation (one level above and one level below the injured segment) for thoracolumbar burst fractures [15], [16], [18].…”

“…Nevertheless, favorable clinical outcomes were also reported using posterior fixation without fusion [9]. Recently, several trials have been conducted comparing the clinical and radiological efficacy of posterior fixation with fusion versus posterior fixation without fusion [14]–[18]. The objective of this meta-analysis was to identify and summarize the evidence from randomized controlled trials (RCTs) on the effectiveness of fusion as a supplement to posterior instrumentation for thoracolumbar burst fractures.…”

Is fusion necessary for thoracolumbar burst fracture treated with spinal fixation? A systematic review and meta-analysis

“…Some studies that compared surgical treatment of thoracolumbar burst fractures with fusion and surgical treatment without fusion pointed to similar results between groups. We found 5 reports in the literature of randomized or quasi-randomized studies 5,6,13,22,25 that were designed to answer this question. Among them, 4 were randomized and 1 was quasi-randomized.…”

“…In the 5-7 years of follow-up, no case of system failure was described in the report by Dai et al 6 Jindal et al 13 reported 2 cases of implant failure 11 and 15 months after surgery in the fusion group and 1 case 7 months after sur- Values are presented as the mean (SD) unless otherwise indicated.…”

A Comparison of Three Different Methods of Fixation in the Management of Thoracolumbar Fractures

“…The goals of treatment in thoracolumbar fractures is to achieve a painless, stable spine with normal neurology and maximum mobility, which is well balanced in the sagittal plane in order to have an ergonomic stance. 1,2,9,10 The treatment of thoracolumbar fractures can be either conservative or surgical. In the majority of cases the outcomes of conservative management satisfy patient and doctors expectations.…”