Abstract: Objective: To assess the functional and radiological outcome of thoracolumbar junction burst fractures treated by long and short segment fixation.
Methods: A prospective study included 40 patients with thoracolumbar junction burst fractures, 20 patients treated with long and 20 patients treated with short segment posterior transpedicular screw fixation at spine injury center, Sanjay Gandhi Institute of trauma and orthopedics, Bangalore from January 2017 to February 2019. Clinical outcome was assessed using Modified Macnab criteria, ODI scoring system and VAS score and radiological assessment was done using Cobb angle, Becks index and segmental kyphotic deformity.
Results: Our study showed predominant male population (80%) with working age group (31-40yrs) who had unstable thoracolumbar junctional burst fractures. Most common mode of injury was fall from height (60%). Patients were divided randomly into 2 groups and group 1 (20 patients) had undergone short segment transpedicular screw fixation, while group 2 (20 patients) had undergone long segment fixation. Regular follow up was done at 3, 6, 9 months and 1 year and all patients were evaluated thoroughly for radiological and functional outcomes. At the end of 12 months of follow up, according to modified Macnab criteria, 28.6% had excellent, 70% had good and 5% had fair outcomes in short segment fixation while 45 % had excellent and 55% had good outcomes in long segment fixation. Mean VAS scores in short segment fixation was 1.33 and long segment 1.10, mean ODI score in short segment was 6.30 and long segment was 6.80. Mean kyphotic deformation before surgery was 14.05 degrees and after correction was 9.2 degrees in short segment and before surgery was 15.45 degrees and after correction was 5.6 degrees in long segment fixation. Our study showed long segment fixation have better results in terms of correction of deformity. Mean Cobb’s angle in short segment fixation was 15.8 degrees before surgery and 12.5 degrees after fixation, in long segment fixation before surgery was 18.6 degrees and after surgery was 7.15 degrees. Becks index in short segment fixation before surgery was 0.68 and 0.80 after surgery, and in long segment fixation was 0.59 before surgery and 0.82 after surgery.
Conclusion: Our data identified a trend towards better clinical and radiological outcomes in the long segment transpedicular fixation, compared to the short segment transpedicular group.
