The Outcomes of Short and Long Segment Posterior Instrumentation of Thoracolumbar Burst Fractures with a Load Sharing Score of 7 or More

Jeong Ho Seo; Kyu Yeol Lee

doi:10.4184/jkss.2015.22.3.92

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Seo and Lee: The Outcomes of Short and Long Segment Posterior Instrumentation of Thoracolumbar Burst Fractures with a Load Sharing Score of 7 or More

Original Article

Journal of Korean Spine Surg 2015;22(3):92-98.

Published online: 21 September 2015

DOI: https://doi.org/10.4184/jkss.2015.22.3.92

The Outcomes of Short and Long Segment Posterior Instrumentation of Thoracolumbar Burst Fractures with a Load Sharing Score of 7 or More

Jeong Ho Seo, M.D., Kyu Yeol Lee, M.D., Ph.D.

Department of Orthopedic Surgery, College of Medicine, Dong A University

Corresponding author: Kyu Yeol Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 1, Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea TEL: +82-51-240-2867, FAX: +82-51-243-9764 E-mail: gylee@dau.ac.kr

Received 9 July 2015 Revised 10 July 2015 Accepted 1 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective.

Objectives

To investigate outcomes between short and long segment posterior instrumentation of thoracolumbar burst fractures with a load sharing score of 7 or more.

Summary of Literature Review

Short segment instrumentation has been recommended in thoracolumbar burst fractures with a load sharing score of 6 or less, and long segment instrumentation has been recommended for those with a score of 7 or more. However, this standard is controversial.

Materials and Methods

From March 2006 to January 2014, 45 patients with thoracolumbar fractures with a load sharing score of 7 or more were treated with posterior instrumentation. They were divided into two groups: short (group S) and long segment (group L) groups. Radiologic results were evaluated on the basis of the kyphotic angle and anterior column height. Complications were also reviewed.

Results

Groups S and L consisted of 13 and 32 patients and had mean ages of 48.3 and 47.3 years, respectively. In group S, the anterior column height increased from 56.62% to 76.23% postoperatively, and remained at 71.15% at followup. The kyphotic angle decreased from 16.27° to 7.55° postoperatively, and was 13.17° at followup. In group L, the anterior column height recovered from 49.67% to 70.52% postoperatively, and was 63.73% at followup. The kyphotic angle decreased from 20.08° to 6.80° postoperatively, and was 14.18° at followup. The changes in the anterior column height and kyphotic angle were not significantly different between groups S and L. Seven cases had complications and the number of cases with complications was not significantly different between groups S and L.

Conclusions

Short and long segment instrumentation of thoracolumbar fractures with a load sharing score of 7 or more did not achieve significantly different results.

Keywords: Thoracolumbar, Burst, Segment, Fracture, Load sharing

REFERENCES

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Figures and Tables%

Fig. 1.

A 48-year-old male patient with an L1 burst fracture treated by short segment pedicle screw fixation. (A) Preoperative radiograph (B) Postoperative radiograph (C) Preoperative computed tomography

Fig. 2.

A 27-year-old male patient with an L1 burst fracture treated by long segment pedicle screw fixation. (A) Preoperative radiograph (B) Postoperative radiograph (C) Preoperative computed tomography

Table 1.

Load Shearing Classification of Spine Fractures

Score	Comminution/Involvement(%)	Apposition of fracture fragment(mm)	Deformity correction(°)
1	<30(little)	<1(minimal)	<3(little)
2	30-60(more)	1-2(spread)	4-9(more)
3	>60(gross)	>2(wide)	>10(most)

Table 2.

Demographic Data

		Group L(%)	Group S(%)	p-value
Gender	Male	21(72.4)	8(27.6)	0.795
Gender	Female	11(68.8)	5(31.3)	0.795
Age		47.3	48.3	0.907
*BMI		22.7±2.7	23.8±1.3	0.16
^T LSS	7	22(66.7)	11(33.3)	0.469
	8	8(80)	2(20)
	9	2(100)	0(0)
Complications	Yes	6(85.7)	1(14.3)	0.065
Complications	No	26(68.4)	12(31.6)	0.065

^∗ BMI: bone mass index,

^T LSS: load sharing score.

Table 3.

Comparison of Vertebral Body Height and Kyphotic Angle

Patients		Vertebral body height(%)					Kyphotic angle(°)
Patients		Preop.	Postop.	Last followup	*Changes	p-value	Postop.	Postop.	Last followup	*Changes(%)	p-value
Group S	13	56.62±11.72	76.23±14.58	71.15±14.58	5.08±9.43	0.669	16.27±5.93	7.55±5.25	13.17±7.74	5.62±4.1	0.354
Group L	32	49.67±18.66	70.52±18.58	63.73±21.46	6.78±12.92	0.669	20.08±7.27	6.80±5.36	14.18±10.89	7.38±8.4	0.354

^∗ Changes: values of postoperative – last followup.

Table 4.

Factors Affecting Changes of Vertebral Body Height and Kyphotic Angle

		Patients	Vertebral body height(%)		Kyphotic angle(o)
		Patients	^T Changes	p-value	^T Changes	p-value
Gender	Male	29	5.58±11.15	0.597	7.1±7.98	0.781
Gender	female	16	7.58±13.53	0.597	6.45±6.49	0.781
Age	<65	41	5.97±11.92	0.639	6.42±7.53	0.194
Age	≥65	4	9.55±13.43	0.639	11.5±4.43	0.194
*BMI	<25	35	7.78±12.18	0.119	7.16±7.98	0.634
*BMI	≥25	10	1.08±9.85	0.119	5.87±5.18	0.634
Complication	Yes	7	16.64±6.79	0.040	12.99±2.17	0.078
Complication	No	23	5.59±2	0.040	6.75±1.75	0.078
LSS	7	33	4.43±9.34	0.133	5.85±7.15	0.299
	8	10	9.88±17.82		9.99±7.38
	9	2	19.13±6.53		8.15±12.52
Fracture level	T11	3	16±7.73	0.428	10.33±11.81	0.252
	T12	11	4.2±9.74		4.25±5.02
	L1	19	7.32±13.47		8.93±7.56
	L2	12	4.16±11.78		5.15±7.58

^∗ BMI: bone mass index,

^T Changes: values of postoperative – last followup, LSS: load sharing score.

Table 5.

Factors Affecting Complications

		Patients	Mean± SD	p-value
Age(yr)	Yes	7	56.29±14.45	0.073
Age(yr)	No	38	46.39±12.84	0.073
*BMI	Yes	7	23.28±2.2	0.771
*BMI	No	38	22.99±2.48	0.771
^T LSS	Yes	7	7.71±0.76	0.036
^T LSS	No	38	7.24±0.49	0.036

^∗ BMI: bone mass index,

^T LSS: load sharing score, SD: standard deviation.

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