Thoracolumbar Compression Fractures
Conditions
Brief summary
To compare the radiological, clinical and functional outcomes of short-segment versus long-segment transpediclular screw fixation in patients with thoracolumbar fractures AO-type B.
Detailed description
Thoracolumbar fractures represent the most common spinal injuries, predominantly occurring at the T11-L2 junction due to the biomechanical transition from the rigid thoracic to the mobile lumbar spine. This region accounts for approximately half of all traumatic spinal fractures, owing to changes in spinal curvature, facet joint orientation, and load-bearing mechanics (1). Surgical management aims to restore spinal stability, correct kyphotic deformity, decompress neural elements, and enable early mobilization. Two posterior fixation strategies exist: short-segment fixation (SSF), spanning one level above and below the fracture with one or 2 intermediate screws in the fractured vertebra itself, and long-segment fixation (LSF), spanning two or more levels above and below with one or 2 intermediate screws in the fractured vertebra itself. Short-segment constructs preserve more motion segments with reduced surgical morbidity, while long-segment constructs provide potentially greater stability (2). The optimal choice remains debated. A 2025 meta-analysis of 17 trials (1,031 patients) showed that LSF was associated with higher blood loss and longer operative time but better kyphosis correction maintenance and pain improvement (3). Short-segment fixation with intermediate screws at the fracture level has shown comparable results to LSF while preserving motion segments and reducing costs (4). There is no randomized trial on AO-type B. Given these controversies, a prospective comparative study in our population is warranted.
Interventions
PROCEDUREShort Segment Versus Long Segment Transpedicular Screw Fixation in the Correction and Preservation of AO-Type B Thoracolumbar Fracture Alignment: A Comparative Study
Thoracolumbar fractures represent the most common spinal injuries, predominantly occurring at the T11-L2 junction due to the biomechanical transition from the rigid thoracic to the mobile lumbar spine. This region accounts for approximately half of all traumatic spinal fractures, owing to changes in spinal curvature, facet joint orientation, and load-bearing mechanics (1). Surgical management aims to restore spinal stability, correct kyphotic deformity, decompress neural elements, and enable early mobilization. Two posterior fixation strategies exist: short-segment fixation (SSF), spanning one level above and below the fracture with one or 2 intermediate screws in the fractured vertebra itself, and long-segment fixation (LSF), spanning two or more levels above and below with one or 2 intermediate screws in the fractured vertebra itself. Short-segment constructs preserve more motion segments with reduced surgical morbidity, while long-segment constructs provide potentially greater stabi
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-65 years * Acute traumatic thoracolumbar fracture (AO type B) * Single-level fracture * Neurologically intact patient (ASIA E)
Exclusion criteria
* Pathological fractures (malignancy, infection, metabolic bone disease) * Significant neurological deficit (ASIA A-D) * Previous spinal surgery at or adjacent to the fracture level * 2 or more level fractures * Associated anterior column reconstruction requirement (corpectomy) * Polytrauma precluding early spinal surgery * Pregnancy * Performance of surgical decompression
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| • Maintenance of correction | baseline | • Maintenance of correction (change in cobb angle from immediate postoperative to final follow-up at 12 months) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Operative kyphosis correction | Baseline | Operative kyphosis correction (change in cobb angle from preoperative to immediate postoperative) |
| • Anterior vertebral body height ratio restoration | from pre operative to last follow up at 12 months | — |
| VAS | pre operative, post operative, at 3, 6 and 12 months follow-up | VAS pain scores at all time points |
| ODI | pre operative, post operative and at 3, 6 and 12 months follow up | ODI functional outcome scores at all time points |
Countries
Egypt
Contacts
CONTACTAhmed Fawzy Ahmed Nafady, master
Outcome results
None listed