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Transpedicular Fixation in Management of Thoracolumbar Burst Fractures: Monosegmental Fixation Versus Short-Segment Instrumentation

Wei, Fu-Xin MD; Liu, Shao-Yu MD; Liang, Chun-Xiang MD; Li, Hao-Miao MD; Long, Hou-Qing MD, PhD; Yu, Bin-Sheng PhD; Chen, Bai-Ling MD, PhD; Chen, Ke-Bing MD

doi: 10.1097/BRS.0b013e3181d7ad1d
Surgery

Study Design. A prospective clinical trial was conducted.

Objective. To compare the clinical and radiologic late results of monosegmental transpedicular fixation versus short-segment pedicle instrumentation (SSPI) in management of thoracolumbar burst fractures and evaluate the efficacy of monosegmental transpedicular fixation.

Summary of Background Data. SSPI (1 level above and 1 below the fracture level) are accepted by many surgeons as an accepted technique for the treatment of thoracolumbar burst fractures. To preserve more motion segments, some authors have advocated monosegmental pedicle instrumentation (MSPI). The recent developments showed that MSPI yielded good clinical results; however, there were no report about comparison of clinical outcome between monosegmental and biosegmental transpedicular fixation in management of thoracolumbar burst fractures.

Methods. Eighty-five patients with thoracolumbar burst fractures fulfilling the inclusion criteria were included in the study. The patients were randomized by a simple method into 2 groups. Group 1 were treated with monosegmental transpedicular fixation (n = 47), and group 2 were treated with biosegmental transpedicular fixation (n = 38). Clinical (Low Back Outcome Score and Oswestry Disability Index) and radiologic (load-sharing classification index, sagittal index, and percentage of anterior body height compression) outcomes were analyzed.

Results. The 2 groups were similar in age, follow-up period, and severity of the deformity and fracture. The postoperative and follow-up sagittal index, local kyphosis, percentage of anterior body height compression, and average correction loss in local kyphosis in both groups were not significantly different. The failure rate between the 2 surgical approaches was also not significantly different (group 1 = 6.38% and group 2 = 5.26%). Oswestry Disability Index improved in both groups by >25 points in a similar amount (P = 0.23). The average follow-up Low Back Outcome Score was 74.9 and 60.2 for group 1 and group 2, respectively (P = 0.033).

Conclusion. In conclusion, radiologic parameters demonstrated that both MSPI and SSPI are the effective and reliable operative techniques for selected thoracolumbar burst fractures. MSPI shortened the operative time and decreased the amount of blood loss significantly and, thus, offered better clinical results. Nevertheless, long-term studies are supposed to be performed to support the outcomes.

The purpose of this prospective clinical trial was to compare the results of monosegmental pedicle instrumentation (MPI) versus short-segment pedicle instrumentation in the management of thoracolumbar burst fractures. The results showed that both of them are the effective and reliable operative techniques for selected thoracolumbar burst fractures. MPI shortened the operative time and decreased the amount of blood loss significantly and, thus, offered better clinical results.

From the Department of Spinal Surgery, Huangpu Division of First Affiliated Hospital, Sun-Yat Sen University, Guangzhou, Guangdong, People's Republic of China.

Acknowledgment date: September 29, 2009. First revision date: November 13, 2009. Second revision date: December 7, 2009. Acceptance date: December 17, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

The first two authors contributed equally to this article.

Address correspondence and reprint requests to Shao-Yu Liu, MD, No.183, Huangpu East Road, Guangzhou, Guangdong, People's Republic of China or Department of Spinal Surgery, Huangpu Division of First Affiliated Hospital, Sun-Yat Sen University, Guangzhou, Guangdong, People's Republic of China; E-mail: gzsyliu@tom.com

© 2010 Lippincott Williams & Wilkins, Inc.