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Fusion May Not Be a Necessary Procedure for Surgically Treated Burst Fractures of the Thoracolumbar and Lumbar Spines: A Follow-up of at Least Ten Years

Chou, Po-Hsin MD; Ma, Hsiao-Li MD; Wang, Shih-Tien MD; Liu, Chien-Lin MD; Chang, Ming-Chau MD; Yu, Wing-Kwong MD

Journal of Bone & Joint Surgery - American Volume: 15 October 2014 - Volume 96 - Issue 20 - p 1724–1731
doi: 10.2106/JBJS.M.01486
Scientific Articles
Supplementary Content
Disclosures

Background: The surgical results of treating thoracolumbar and lumbar burst fractures were reported to be comparable between patients with and without fusion in an intermediate-term follow-up. To our knowledge, no prior report has compared the results of fusion and non-fusion with long-term follow-up.

Methods: This study was designed to provide long-term evaluation of patients with a burst fracture of the thoracolumbar and lumbar spine treated with short-segment fixation who were randomly assigned to a fusion or non-fusion group. Patients older than sixty years of age at the time of injury and those who were lost to follow-up were excluded. Functional outcomes were evaluated using the Greenough Low-Back Outcome Score and the visual analog scale for back pain. Radiographic outcomes were focused on the vertebral body height of the injured vertebra, the kyphotic angle, and the regional segmental motion.

Results: Twenty-two patients were enrolled in the non-fusion group, and twenty-four patients were enrolled in the fusion group. The average follow-up period was 134 months (range, 121 to 161 months). The average preoperative kyphotic angle was 16.4° for the non-fusion group and 19.5° for the fusion group. The average postoperative kyphotic angle was 1.5° for the non-fusion group and 4.0° for the fusion group. At the time of the latest follow-up, the average kyphotic angle was 13.8° for the non-fusion group and 14.7° for the fusion group. The average kyphotic angle between the two groups was similar at all follow-up times. A progressive decrease of the kyphotic angle was significant (p < 0.05) with time, regardless of fusion. The radiographic outcomes were similar between these two groups at all follow-up times, as were functional outcomes. More patients in the non-fusion group underwent additional surgery to remove implants. Regional segmental motion was preserved in the non-fusion group, with a mean motion (and standard deviation) of 4.2° ± 1.9°.

Conclusions: The long-term results of short segmental fixation with and without fusion for burst fractures of the thoracolumbar and lumbar spine were comparable. Regional segmental motion could be preserved without fusion, and bone graft donor site complications could be eliminated.

Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

1School of Medicine, National Yang-Ming University, Taipei, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan, Republic of China. E-mail address for S.-T. Wang: stwang@vghtpe.gov.tw

2Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, 112, Taiwan, Republic of China

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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