title: Monosegmental vs bisegmental pedicle fixation for the treatment of thoracolumbar spine fractures.
abstract: BACKGROUND
  The anatomy and biomechanics of the thoracolumbar spine place these segments at high risk of trauma injuries. Treatment options are either conservative or surgical, and there is a lack of consensus about the right indications. International scientific publications agree only on basic surgical principles: vertebral stability, deformity correction, protection of neurological structures and fast functional recovery. The most commonly used approach is the posterior approach, which allows the best management of most vertebral fracture patterns. The aim of this study was to compare clinical and radiological outcomes of monosegmental stabilisation with those of bisegmental stabilisation and fusion in the treatment of traumatic thoracolumbar spine fractures.
  
  
  METHODS
  This retrospective clinical and radiological study evaluated 48 consecutive patients treated with monosegmental (Group M; n=14) or bisegmental (Group B; n=34) posterior pedicular instrumentation for thoracolumbar fractures. Fractures were classified by the new AO Spine TLIC system. Average follow-up was 30 months. Clinical outcomes in both groups were statistically compared. Radiological outcomes were evaluated in terms of vertebral anterior body height restoration and correction of the kyphotic deformity.
  
  
  RESULTS
  Radiographical results showed no statistically significant difference between the two groups in vertebral body height restoration and correction of the kyphotic deformity. The mean postoperative somatic vertebral anterior body height in Group M was 25.8±4.52mm and in Group B it was 24.43±4.27mm. In Group M the mean postoperative kyphotic deformity was 11.10±5.71°, in Group B it was 9.09±4.93°.
  
  
  CONCLUSIONS
  The results of this study confirm the validity of short and very short instrumentation for the treatment of well-selected type A and B vertebral fractures. In C type fractures correct surgical indication must be evaluated on an individual basis.
authors.affiliation: Spine Surgery Department, Orthopaedic Institute "Gaetano Pini", Milan, Italy.
authors.forename: Giovanni Andrea
authors.initials: GA
authors.lastname: La Maida
authors.affiliation: University of Milan, Italy. Electronic address: f.luceri88@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Luceri
authors.affiliation: Spine Surgery Department, Orthopaedic Institute "Gaetano Pini", Milan, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Ferraro
authors.affiliation: University of Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ruosi
authors.affiliation: University of Milan, Italy.
authors.forename: Giuseppe Vincenzo
authors.initials: GV
authors.lastname: Mineo
authors.affiliation: Spine Surgery Department, Orthopaedic Institute "Gaetano Pini", Milan, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Misaggi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome
keywords: Thoracolumbar fractures; bisegmental stabilisation; monosegmental stabilisation; short fusion