title: Inclusion of the fracture level in short segment fixation of thoracolumbar fractures.
abstract: Short segment posterior fixation is the preferred method for stabilizing thoracolumbar fractures. In case of significant disruption of the anterior column, the simple short segment construct does not ensure adequate stability. In this study, we tried to evaluate the effect of inclusion of the fractured vertebra in short segment fixation of thoracolumbar fractures. In a prospective randomized study, eighty patients with thoracolumbar fractures treated just with posterior pedicular fixation were randomized into two groups receiving either the one level above and one level below excluding the fracture level (bridging group), or including the fracture level (including group). Different clinical and radiological parameters were recorded and followed. A sum of 80 patients (42 patients in group 1 and 38 patients in group 2) were enrolled in the study. The patients in both the groups showed similar clinical outcome. There was a high rate of instrumentation failure in the "bridging" group. The "bridging" group showed a mean worsening (29%) in kyphosis, whereas the "including" group improved significantly by a mean of 6%. The significant effect of the "including" technique on the reduction of kyphotic deformity was most prominent in type C fractures. In conclusion, inclusion of the fracture level into the construct offers a better kyphosis correction, in addition to fewer instrument failures, without additional complications, and with a comparable-if not better-clinical and functional outcome. We recommend insertion of screws into pedicles of the fractured thoracolumbar vertebra when considering a short segment posterior fixation, especially in Magerl type C fractures.
authors.affiliation: Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz Neurosciences Research Center, PO Box 71455-166, Shiraz, Iran.
authors.forename: Majid-Reza
authors.initials: MR
authors.lastname: Farrokhi
authors.forename: Ali
authors.initials: A
authors.lastname: Razmkon
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Maghami
authors.forename: Zahra
authors.initials: Z
authors.lastname: Nikoo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D055815:Young Adult