Comparison of the clinical and radiological results of short and long segment posterior instrumentation in the treatment of unstable thoracolumbar vertebra junction fractures

Aim: Posterior pedicle screw fixation is generally preferred in unstable thoracolumbar vertebra junction fractures. But, the application of short- or long-segment instrumentation is still controversial. The aim of this study was to compare the clinical and radiological results of the patients who underwent conventional long-segment posterior instrumentation with short segment posterior instrumentation in which fracture level was included in unstable thoracolumbar vertebra junction fractures. Materials and Methods: Dicle University Faculty of Medicine, Department of Orthopedics and Traumatology between 2010-2017, The patients who underwent surgery for an unstable thoracolumbar vertebra junction fracture (T12-L1) were divided into two groups according to the level of instrumentation. 21 patients who underwent posterior instrumentation in the short segment (consisting of 6 screws in which the fracture level was included) and 21 patients who underwent posterior instrumentation in the long segment (consisting of 8 screw screws without fracture vertebrae) were retrospectively analyzed. Preoperative radiography, MRI, CT, postoperative radiography and final control radiographs were evaluated. Local kyphosis angle (LKA), Sagittal index (SI), Cob angle (CA), Anterior body height loss (ACYK), Anterior body height / Posterior body height (ACY / PCY) were measured of the patients. Two groups were evaluated in terms of trauma, operative time, operation time, Magerl classification, follow-up period, hospital stay, complication and implant failure. Neurological status of the patients was evaluated according to Frankel scale. Functional results of the cases were evaluated with VAS and Oswestry scales. Results: There was no difference between the two groups in terms of gender, type of trauma, fracture level, additional orthopedic injury, time of operation, complication, duration of hospitalization, follow-up period, implant failure and complication (p> 0.05). There was no difference between the two groups in terms of preoperative ACYK, ACY / PCY (p> 0.05). There was a statistically significant difference between the two groups in the long-segment group Preop LKA, SI, CA (p <0.05).The number of patients in the long segment in terms of Magerl's referral was higher in Type B patients, there was a difference between the two groups (p = 0.02).There was no difference between postoperative and postoperative LKA, SI, CA, ACYK, ACY / PCY radiological measurements between the two groups (p> 0.05).At the last follow-up, there was no significant difference between the two groups in terms of loss of correction.The duration of operation was shorter in the short-segment group. There was a significant difference between the two groups in terms of operative time (p = 0.000).At the last follow-up, VAS (P = 0,243) and Oswestry (P = 0,326) scores were not different between the two groups. Conclusions: Inclusion of fracture level in a short-segment fixation for a thoracolumbar junction fractures results in a kyphosis correction and in a maintenance of the sagittal alignment similar to a long-segment instrumentation. But, Because the operation time is shorter and leads to less segmental movement loss, short segment posterior instrumentation is a treatment modality that can be preferred to long segment posterior instrumentation. Keywords: Inclusion of fracture level, long-segment, short-segment, pedicle screw, Thoracolumbar fractures