Journal of Clinical and Diagnostic Research. 2018 Dec, Vol-12(12): RC01-RC04 1 1 DOI: 10.7860/JCDR/2018/38277.12353 Original Article Orthopaedics Section Comparison of Posterior Short-segment Pedicle Screw Fixation with or without Fusion in Thoracolumbar Burst Fractures ARVIND BHARADWAJ 1 , AKSHAY RAKESHMOHAN BHARDWAJ 2 , GAURAV MAHESH SHARMA 3 Keywords: Kyphosis, Unstable fractures, Vertebra ABSTRACT Introduction: Treatment of unstable Thoracolumbar vertebra burst fractures has seen a paradigm shift from conservative to surgical modalities with either a short or long-segment posterior fixation with or without fusion. Aim: To assess the functional and radiological outcome in burst fractures of thoracolumbar vertebrae treated with short- segment posterior instrumentation with and without fusion. Materials and Methods: The study was conducted on 31 patients, divided into two groups, with thoracolumbar burst fractures. Patients above18 years of age, with or without neurological deficit, Kyphosis>300, anterior vertebral height loss >50%, spinal canal narrowing >40% were included in the study. Group A (n=15) had patients in which posterior short- segment pedicle screw fixation was done while patients with pedicle screw fixation combined with posterolateral fusion were in Group B (n=16). The final outcome was measured using the Modified Mcnab’s questionnaire, low back outcome scale of Greenough and Fraser and Frankel scoring system at an interval of 3,6 and 12 months were calculated using the Mann-Whitney’s U-test which was not statistically significant (p=0.770). Results: The most common mode of injury was road traffic accident affecting 23 (74.2%) cases. L1, L2 and T12 were the most commonly involved vertebrae. The time duration between the injury and surgery was 12.44±9.6 days in Group A and 8.6±2.7 days in Group B (p=0.1273). Intraoperative blood loss was 468±94.6 mL in Group A and 693±88.3 mL in Group B (p<0.001). The mean surgical time in Group B cases (149.33±4.72 minutes) was more than those in Group A (110.8±4.65 minutes) (p<0.001). The average duration of hospital stay was 27.8±7.33 days in Group A and 24.3±8 days in Group B (p=0.3056). There was a gradual improvement in Frankel scoring, anterior vertebral height and kyphotic angle at last follow-up. The Greenough low back outcome score was 45.25 in Group A and 46.10 in Group B cases which were not significant. As per the modified Mcnab’s questionnaire, 17 (54.83%) had excellent, 10 (32.2%) had good and 4 (12.9%) had the poor functional outcome. Superficial infection and screw loosening were apparent in 3 (9.6%) cases. Conclusion: Posterolateral fusion combined with fixation is not superior to fixation alone in burst thoracolumbar fractures. INTRODUCTION Vertebral column fractures are reported to occur in about 6% of trauma patients, with half of them involving the spinal cord or the nerve root [1]. About half of the burst fractures involve thoracolumbar region owing to the presence of biomechanically weak junction especially between T11 and L2 vertebra [2]. As per Denis, burst fractures involve the failure of at least the anterior and middle columns of the spine [3]. These fractures can occur as a result of high-velocity trauma in young adults while a trivial fall from standing position can lead to such fractures in geriatric age group due to the osteoporosis [3]. It is estimated that around 20%-40% of these injuries are associated with neurological deficit which can be associated with kyphotic deformity [2]. The ideal treatment modality to be used in burst fractures of thoracolumbar region still remains controversial with no established consensus for the same [4-6]. Non-operative options include rest, use of brace, moulded orthosis or hyperextension cast with early mobilisation. Rotorest bed has proved to be effective even in severe fractures [4,7]. Conservative methods can sometimes lead to worsening of spinal stenosis, increasing the pressure on vertebral body or worsening of neurological symptoms. Indications for surgery include progressive neurological deterioration or an incomplete neuro deficit, kyphotic deformity >300, >50% loss of vertebral body height, canal narrowing of >40%-50% [8,9]. Surgical options can comprise of either an anterior or posterior approach. Anterior corpectomy and fixation have shown good results, however, increased morbidity and steep learning curve are the main constraints for its routine use [10]. Posterior approach, on the other hand, is technically easy to perform and is less extensive. Various modifications have been made in terms of instrumentation and technique. Pedicle screws can minimise the range of movements at spinal segments which can further reduce the damage to soft tissues and increase the rate of synostosis giving a three column fixation [11]. The fixation can either be short or a long-segment. Short-Segment instrumentation involves one level cephalad and one level caudal pedicle screw fixation whereas the long-segmental instrumentation involves more than three levels. Literature has shown variable results with the use of short-segment fusion with some studies favouring it [10,12], while others have shown high failure rate [13]. Long- segment instrumentation has shown to have a good clinical and functional outcome in few studies [12,13]. While several studies recommend posterior fixation augmented with fusion [14-16], there are few studies which suggest that fusion offers no added advantage [2,17-20]. The aim of the present study was to compare the functional and radiological outcome in patients with thoracolumbar burst fractures treated by short-segment pedicle screw fixation with or without posterolateral fusion. Authors hypothesis was that there was no difference between both the techniques and that the posterolateral fusion offers no added advantage when combined with fixation.