title: Short versus long-segment posterior fixation in the treatment of thoracolumbar junction fractures: a comparison of outcomes.
abstract: OBJECTIVE
  To compare clinical and radiological outcomes between short (SSPF) and long-segment (LSPF) posterior fixation for thoracolumbar junction (TLJ) fractures.
  
  
  METHODS
  Retrospective review of adult patients, with single-level, TLJ (T11-L2) fractures, treated with posterior fixation between 2007 and 2014 at a regional spinal centre. SSPF and LSPF were defined as transpedicular screw fixation at one and two levels above and below the fractured vertebra, respectively. Construct failure was defined as instrument breakage or screw pull-out requiring operative intervention. Two independent assessors measured the kyphotic Cobb angle at up to six months.
  
  
  RESULTS
  A total of 28 patients were included with a median age of 38 years (range 20-76 years) and median follow-up period of 14 months (4-41 months). All patients sustained traumatic fractures and the male to female ratio was 19:9. AO fracture classes were: A (29%), B (50%) and C (21%). SSPF and LSPF were performed in 17 (61%) and 11 (39%) patients, respectively. There was no significant difference in age (Fisher's exact, p > 0.99), AO fracture class (chi-squared, p = 0.510), preop TLICS score (independent t-test, p = 0.668) and length of stay (independent t-test, p = 0.106) between the groups. Construct failure occurred in three SSPF cases (3-14 months postop) and was associated with an increased mean loss of correction. By six months, the Cobb angle had increased significantly in the SSPF group (paired t-test, p = 0.049), but not the LSPF group (paired t-test, p = 0.157).
  
  
  CONCLUSIONS
  Our data identified a trend towards better clinical and radiological outcomes in the LSPF, compared to the SSPF group. Although supported by some studies, these findings should be evaluated in future clinical trials.
authors.affiliation: a Department of Spinal Surgery , Salford Royal NHS Foundation Trust , Manchester , UK.
authors.forename: Mueez
authors.initials: M
authors.lastname: Waqar
authors.affiliation: a Department of Spinal Surgery , Salford Royal NHS Foundation Trust , Manchester , UK.
authors.forename: Dmitri
authors.initials: D
authors.lastname: Van-Popta
authors.affiliation: b Department of Neurosurgery , The Walton Centre NHS Foundation Trust , Liverpool , UK.
authors.forename: Damiano Giuseppe
authors.initials: DG
authors.lastname: Barone
authors.affiliation: c Department of Neuroradiology , The Walton Centre NHS Foundation Trust , Liverpool , UK.
authors.forename: Maneesh
authors.initials: M
authors.lastname: Bhojak
authors.affiliation: b Department of Neurosurgery , The Walton Centre NHS Foundation Trust , Liverpool , UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Pillay
authors.affiliation: b Department of Neurosurgery , The Walton Centre NHS Foundation Trust , Liverpool , UK.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Sarsam
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Thoracolumbar; fixation; fracture; long-segment; short-segment; trauma