TREATMENT OF THORACOLUMBAR JUNCTION FRACTURES: SHORT SEGMENT VS LONG SEGMENT FIXATION
Main Article Content
Keywords
Spine fractures, spinal fusion, thoracolumbar, short, long
Abstract
Background: TJ fractures because the T11-L2 vertebrae are especially susceptible to fracture. Most of these injuries need surgical intervention and two classifications of techniques that can be employed include short segment and long segment fixation which is performed to regain spinal stability and to minimize neurological compromise.
Objectives: to examine the effectiveness of short segment and long segment fixation when treating thoracolumbar junction fractures in terms of clinic outcomes, stability and complications.
Study design : A prospective study
Place and duration of study. January 2023 to December 2023 Jinnah Postgraduate Medical Centre, Neuro Surgery Department
Methods: Those patients involved in this study were 150 with TNJF who were randomly divided into short segment (75) and long segment fixation (75). Patients were assessed for radiological at 6 and 12 months after surgery in terms of pain, and complications associated outcomes. Multivariate data was analyzed using means, standard deviations and P values to determine if there was a significant difference between the groups.
Results: In the short segment group the mean pain score reduced from 7. 2 (±1. 3) Pre op to 2. 4 (±0. 9) at 12 months. In the long segment group the pain score reduced from 7. 3 (± 1. 4) to 2. 1 (± 0. 8). New bone formation ratio was 87% in the short segment group and 85% in the long segment group while radiological stability was accomplished in 92% of the short segment group and 94% in the long segment group. There was also a statistical difference in the overall rates in the two groups; p= 0. 045 where the long segment group had 15% complications as opposed to the 8% in the short segment group.
Conclusions: Short segment and long segment fixation were reported as reasonable ways to stabilise the thoracolumbar junction fractures. At the same time, short segment fixation was associated with a lower rate of complications but at the same level of radiological efficacy; hence, the latter is preferable in some cases.
Objectives: to examine the effectiveness of short segment and long segment fixation when treating thoracolumbar junction fractures in terms of clinic outcomes, stability and complications.
Study design : A prospective study
Place and duration of study. January 2023 to December 2023 Jinnah Postgraduate Medical Centre, Neuro Surgery Department
Methods: Those patients involved in this study were 150 with TNJF who were randomly divided into short segment (75) and long segment fixation (75). Patients were assessed for radiological at 6 and 12 months after surgery in terms of pain, and complications associated outcomes. Multivariate data was analyzed using means, standard deviations and P values to determine if there was a significant difference between the groups.
Results: In the short segment group the mean pain score reduced from 7. 2 (±1. 3) Pre op to 2. 4 (±0. 9) at 12 months. In the long segment group the pain score reduced from 7. 3 (± 1. 4) to 2. 1 (± 0. 8). New bone formation ratio was 87% in the short segment group and 85% in the long segment group while radiological stability was accomplished in 92% of the short segment group and 94% in the long segment group. There was also a statistical difference in the overall rates in the two groups; p= 0. 045 where the long segment group had 15% complications as opposed to the 8% in the short segment group.
Conclusions: Short segment and long segment fixation were reported as reasonable ways to stabilise the thoracolumbar junction fractures. At the same time, short segment fixation was associated with a lower rate of complications but at the same level of radiological efficacy; hence, the latter is preferable in some cases.
References
1. Vaccaro AR, Kim DH, Brodke DS, et al. Diagnosis and management of thoracolumbar spine fractures. J Bone Joint Surg Am. 2003;85-A(12):2456-70.
2. Reinhold M, Knop C, Beisse R, et al. Operative treatment of traumatic fractures of the thoracolumbar transition. Orthopade. 2009;38(9):745-56.
3. Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184-201.
4. Lee JY, Vaccaro AR, Lim MR, et al. Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. J Orthop Sci. 2005;10(6):671-5.
5. Esses SI, Botsford DJ, Wright T, et al. Operative treatment of spinal fractures with short segment pedicle instrumentation. Spine (Phila Pa 1976). 1991;16(8).
6. Sapkas G, Papadakis SA, Katonis P, et al. Surgical outcome of unstable thoracolumbar burst fractures with transpedicular fixation. Clin Orthop Relat Res. 2000;(394):91-9.
7. McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. J Bone Joint Surg Am. 1993;75(2):162-7.
8. 8. Sapkas G, Papadakis SA, Katonis P, et al. Surgical outcome of unstable thoracolumbar burst fractures with transpedicular fixation. Clin Orthop Relat Res. 2000;(394):91-9.
9. Dai LY, Jiang LS, Jiang SD. Posterior short-segment fixation with or without fusion for thoracolumbar burst fractures: a five- to seven-year prospective randomized study. J Bone Joint Surg Am. 2009;91(5):1033-41.
10. McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. J Bone Joint Surg Am. 1993;75(2):162-7.
11. Aebi M. Classification and treatment of thoracolumbar injuries. Spine (Phila Pa 1976). 2010;35(21 Suppl).
12. Kakkar R, Saini S, Sharma V, et al. Comparative study between short segment and long segment fixation for thoracolumbar fractures. Indian J Orthop. 2014;48(1):50-4.
13. Alanay A, Acaroglu E, Yazici M, et al. Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure? Spine (Phila Pa 1976). 2001;26(18):213-6.
14. Kim HS, Kim SW, Ju CI, et al. Analysis of clinical results of short segment pedicle screw fixation for thoracolumbar burst fractures. J Korean Neurosurg Soc. 2007;42(4):317-21.
15. Zhou ZH, Wang B, Huang YM, et al. Selective extension of short segment fixation for thoracolumbar fractures: a new technique for improved clinical outcomes. Orthop Surg. 2019;11(5):811-7.
16. Wood KB, Li W, Lebl DR, et al. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145-64.
2. Reinhold M, Knop C, Beisse R, et al. Operative treatment of traumatic fractures of the thoracolumbar transition. Orthopade. 2009;38(9):745-56.
3. Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184-201.
4. Lee JY, Vaccaro AR, Lim MR, et al. Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. J Orthop Sci. 2005;10(6):671-5.
5. Esses SI, Botsford DJ, Wright T, et al. Operative treatment of spinal fractures with short segment pedicle instrumentation. Spine (Phila Pa 1976). 1991;16(8).
6. Sapkas G, Papadakis SA, Katonis P, et al. Surgical outcome of unstable thoracolumbar burst fractures with transpedicular fixation. Clin Orthop Relat Res. 2000;(394):91-9.
7. McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. J Bone Joint Surg Am. 1993;75(2):162-7.
8. 8. Sapkas G, Papadakis SA, Katonis P, et al. Surgical outcome of unstable thoracolumbar burst fractures with transpedicular fixation. Clin Orthop Relat Res. 2000;(394):91-9.
9. Dai LY, Jiang LS, Jiang SD. Posterior short-segment fixation with or without fusion for thoracolumbar burst fractures: a five- to seven-year prospective randomized study. J Bone Joint Surg Am. 2009;91(5):1033-41.
10. McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. J Bone Joint Surg Am. 1993;75(2):162-7.
11. Aebi M. Classification and treatment of thoracolumbar injuries. Spine (Phila Pa 1976). 2010;35(21 Suppl).
12. Kakkar R, Saini S, Sharma V, et al. Comparative study between short segment and long segment fixation for thoracolumbar fractures. Indian J Orthop. 2014;48(1):50-4.
13. Alanay A, Acaroglu E, Yazici M, et al. Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure? Spine (Phila Pa 1976). 2001;26(18):213-6.
14. Kim HS, Kim SW, Ju CI, et al. Analysis of clinical results of short segment pedicle screw fixation for thoracolumbar burst fractures. J Korean Neurosurg Soc. 2007;42(4):317-21.
15. Zhou ZH, Wang B, Huang YM, et al. Selective extension of short segment fixation for thoracolumbar fractures: a new technique for improved clinical outcomes. Orthop Surg. 2019;11(5):811-7.
16. Wood KB, Li W, Lebl DR, et al. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145-64.
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Aug 23, 2024
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How to Cite
Dr. Mashal Rasool, Dr. Mukhtar Ahmed, Dr. Syeda Sumaiya Gilani, Dr. Ali Raza, Dr. Naseer Ahmad, & Dr. Asmat Ullah. (2024). TREATMENT OF THORACOLUMBAR JUNCTION FRACTURES: SHORT SEGMENT VS LONG SEGMENT FIXATION. Journal of Population Therapeutics and Clinical Pharmacology, 31(8), 2907-2913. https://doi.org/10.53555/xq484w56
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Author Biographies
Dr. Mashal Rasool
Post Graduate Resident FCPS Neurosurgery Jinnah Postgraduate Medical Centre, Karachi.
Dr. Mukhtar Ahmed
Post Graduate Resident FCPS General Surgery Jinnah Postgraduate Medical Centre, Karachi.
Dr. Syeda Sumaiya Gilani
Post Graduate Resident FCPS Neurosurgery Jinnah Postgraduate Medical Centre, Karachi.
Dr. Ali Raza
Post Graduate Resident FCPS General Surgery Pakistan Institute of Medical Sciences, Islamabad.
Dr. Naseer Ahmad
Post Graduate Resident FCPS General Medicine Bolan Medical Complex Hospital Quetta/ Sandeman Provincial Hospital, Quetta. Contact no: 0333-7918009
Dr. Asmat Ullah
Post Graduate Resident FCPS Orthopedic Surgery Bolan Medical Complex Hospital Quetta.
How to Cite
Dr. Mashal Rasool, Dr. Mukhtar Ahmed, Dr. Syeda Sumaiya Gilani, Dr. Ali Raza, Dr. Naseer Ahmad, & Dr. Asmat Ullah. (2024). TREATMENT OF THORACOLUMBAR JUNCTION FRACTURES: SHORT SEGMENT VS LONG SEGMENT FIXATION. Journal of Population Therapeutics and Clinical Pharmacology, 31(8), 2907-2913. https://doi.org/10.53555/xq484w56