Short Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled Trial

Background Data: Selection of stabilization procedures for treating thoracolumbar burst fractures remains controversial. Both long-segment and short-segment pedicle screw fixation including the fractured vertebral body have been used widely with no consensus on the better method. Purpose: To compar...

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Autores principales:	Mohammad El-Sharkawi, Mohamed Abdel Gawad, Al Moataz El Sabrout, Mohamed Hassan
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2017
Materias:	Thoracolumbar Burst Fracture Long-Segment Pedicle Screw Fixation Short-Segment Pedicle Screw Fixation Intermediate Screw Loss of Kyphosis Correction Cobb Angle Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/2b59a41b8f2243ca9e5bee5de9738a10
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spelling	oai:doaj.org-article:2b59a41b8f2243ca9e5bee5de9738a102021-12-02T03:41:43ZShort Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled TrialDOI:10.21608/ESJ.2017.71112314-89502314-8969https://doaj.org/article/2b59a41b8f2243ca9e5bee5de9738a102017-10-01T00:00:00Zhttp://www.esj.journals.ekb.eg/article_7111.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: Selection of stabilization procedures for treating thoracolumbar burst fractures remains controversial. Both long-segment and short-segment pedicle screw fixation including the fractured vertebral body have been used widely with no consensus on the better method. Purpose: To compare between the long segment and short-segment with intermediate screw (s) fixation of thoracolumbar junction burst fractures in terms of radiological and clinical outcomes. Study Design: Prospective randomized controlled trial. Patients and Methods: Fifty consecutive patients (32 males and 18 females, mean age 33.6±14.6 years) with thoracolumbar burst fractures presenting during the period between October 2015 and December 2016 to Assiut University hospital were randomized into one of two groups. Group A (25 patients) was treated by long segment pedicle screw fixation, i.e., fixation of 2 levels above and below the fractured vertebra. Group B (25 patients) was treated by short segment fixation, i.e., 1 level above and 1 level below the fractured vertebra, with one or 2 intermediate screws in the fractured vertebra itself. The study protocol was approved by our institution review board and all patients signed an informed consent. The inclusion criteria were single level Type A3 and A4 fracture at thoracolumbar junction, regardless of their neurological status. All patients were treated within 48 hours from the injury. Monoaxial screws were used in all patients. Assessment of kyphosis correction by using the Cobb method and restoration of the anterior vertebral body height was performed radiologically postoperatively and at 3 and 6 months follow up. The clinical outcomes were evaluated using the modified Macnab criteria in the last follow-up. Radiological and clinical assessment was made by an independent observer. Results: Demographic data of both groups were quite comparable. The mean operative time in Group B was significantly shorter than in group A (85±28 min. and 110±0.59 min. respectively). The mean operative blood loss was also significantly lower in Group B than in Group A (476±133.2cc and 656±195.9cc respectively). There was no significant difference between both groups as regards the degree of local kyphosis angle correction and anterior vertebral body height restoration or the correction loss observed during the follow up. Neurological recovery was observed in all patients. Clinically, 14 (56%) patients in Group A and 21 (84%) patients in group B were within the Excellent/Good categories according to Macnab Criteria, whereas 11 (44%) patients in group A and 4 (16%) patients in Group B (16%) were in Fair/poor Group (P=0.064). No perioperative complications were recorded in either group. Conclusion: Short-segment fixation using monoaxial pedicle screws and including the fractured vertebral body is as effective as long-segment pedicle screw fixation for treating A3 and A4 thoracolumbar burst fractures. It preserves motion segments and reduces the costs of surgery and seems to result in a better clinical outcome. (2017ESJ131)Mohammad El-Sharkawi Mohamed Abdel Gawad Al Moataz El Sabrout Mohamed HassanEgyptian Spine AssociationarticleThoracolumbar Burst FractureLong-Segment Pedicle Screw FixationShort-Segment Pedicle Screw FixationIntermediate ScrewLoss of Kyphosis CorrectionCobb AngleNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 24, Iss 1, Pp 6-13 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Thoracolumbar Burst Fracture Long-Segment Pedicle Screw Fixation Short-Segment Pedicle Screw Fixation Intermediate Screw Loss of Kyphosis Correction Cobb Angle Neurology. Diseases of the nervous system RC346-429
spellingShingle	Thoracolumbar Burst Fracture Long-Segment Pedicle Screw Fixation Short-Segment Pedicle Screw Fixation Intermediate Screw Loss of Kyphosis Correction Cobb Angle Neurology. Diseases of the nervous system RC346-429 Mohammad El-Sharkawi Mohamed Abdel Gawad Al Moataz El Sabrout Mohamed Hassan Short Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled Trial
description	Background Data: Selection of stabilization procedures for treating thoracolumbar burst fractures remains controversial. Both long-segment and short-segment pedicle screw fixation including the fractured vertebral body have been used widely with no consensus on the better method. Purpose: To compare between the long segment and short-segment with intermediate screw (s) fixation of thoracolumbar junction burst fractures in terms of radiological and clinical outcomes. Study Design: Prospective randomized controlled trial. Patients and Methods: Fifty consecutive patients (32 males and 18 females, mean age 33.6±14.6 years) with thoracolumbar burst fractures presenting during the period between October 2015 and December 2016 to Assiut University hospital were randomized into one of two groups. Group A (25 patients) was treated by long segment pedicle screw fixation, i.e., fixation of 2 levels above and below the fractured vertebra. Group B (25 patients) was treated by short segment fixation, i.e., 1 level above and 1 level below the fractured vertebra, with one or 2 intermediate screws in the fractured vertebra itself. The study protocol was approved by our institution review board and all patients signed an informed consent. The inclusion criteria were single level Type A3 and A4 fracture at thoracolumbar junction, regardless of their neurological status. All patients were treated within 48 hours from the injury. Monoaxial screws were used in all patients. Assessment of kyphosis correction by using the Cobb method and restoration of the anterior vertebral body height was performed radiologically postoperatively and at 3 and 6 months follow up. The clinical outcomes were evaluated using the modified Macnab criteria in the last follow-up. Radiological and clinical assessment was made by an independent observer. Results: Demographic data of both groups were quite comparable. The mean operative time in Group B was significantly shorter than in group A (85±28 min. and 110±0.59 min. respectively). The mean operative blood loss was also significantly lower in Group B than in Group A (476±133.2cc and 656±195.9cc respectively). There was no significant difference between both groups as regards the degree of local kyphosis angle correction and anterior vertebral body height restoration or the correction loss observed during the follow up. Neurological recovery was observed in all patients. Clinically, 14 (56%) patients in Group A and 21 (84%) patients in group B were within the Excellent/Good categories according to Macnab Criteria, whereas 11 (44%) patients in group A and 4 (16%) patients in Group B (16%) were in Fair/poor Group (P=0.064). No perioperative complications were recorded in either group. Conclusion: Short-segment fixation using monoaxial pedicle screws and including the fractured vertebral body is as effective as long-segment pedicle screw fixation for treating A3 and A4 thoracolumbar burst fractures. It preserves motion segments and reduces the costs of surgery and seems to result in a better clinical outcome. (2017ESJ131)
format	article
author	Mohammad El-Sharkawi Mohamed Abdel Gawad Al Moataz El Sabrout Mohamed Hassan
author_facet	Mohammad El-Sharkawi Mohamed Abdel Gawad Al Moataz El Sabrout Mohamed Hassan
author_sort	Mohammad El-Sharkawi
title	Short Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled Trial
title_short	Short Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled Trial
title_full	Short Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled Trial
title_fullStr	Short Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled Trial
title_full_unstemmed	Short Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled Trial
title_sort	short versus long segment fixation for thoracolumbar burst fractures: a randomized controlled trial
publisher	Egyptian Spine Association
publishDate	2017
url	https://doaj.org/article/2b59a41b8f2243ca9e5bee5de9738a10
work_keys_str_mv	AT mohammadelsharkawi shortversuslongsegmentfixationforthoracolumbarburstfracturesarandomizedcontrolledtrial AT mohamedabdelgawad shortversuslongsegmentfixationforthoracolumbarburstfracturesarandomizedcontrolledtrial AT almoatazelsabrout shortversuslongsegmentfixationforthoracolumbarburstfracturesarandomizedcontrolledtrial AT mohamedhassan shortversuslongsegmentfixationforthoracolumbarburstfracturesarandomizedcontrolledtrial
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Short Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled Trial

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