Surgical management of thoracolumbar burst fractures by three different posterior techniques: A prospective comparative study

Shivendra Kumar Sinha; Vishal Verma; Anil Regmi; P Venkata Sudhakar; Nikhil Goyal; Siddharth Shekhar Sethy; Aakash Jain; Aman Verma; Pankaj Kandwal; Bhaskar Sarkar

doi:10.1016/j.jcot.2024.102564

Surgical management of thoracolumbar burst fractures by three different posterior techniques: A prospective comparative study

J Clin Orthop Trauma. 2024 Oct 18:58:102564. doi: 10.1016/j.jcot.2024.102564. eCollection 2024 Nov.

Affiliations

¹ Department of Orthopedics, AIIMS, Rishikesh, Uttarakhand, 249203, India.
² Department of Trauma Surgery, AIIMS, Rishikesh, Uttarakhand, 249203, India.

PMID: 39554278
PMCID: PMC11567105 (available on 2025-10-18)
DOI: 10.1016/j.jcot.2024.102564

Abstract

Study design: Prospective Comparative Study.

Objectives: This study aims to study the outcome of thoracolumbar burst fractures by comparison of 3 different posterior constructs groups of patients treated by the posterior approach.

Setting: University level Tertiary care Centre of Northern India.

Methods: Single centre study conducted from September 2020 to April 2022, the study included patients aged 18-50 years with burst fractures in the thoracolumbar region, TLICS score ≥4, and injury surgery duration <3 weeks. Sixty patients were divided into three groups: Group I (short segment with index screw(s) in the fractured vertebrae), Group II (short segment with interbody cage fusion), and Group III (long segment without index screw or interbody cage). Clinical and radiological assessments were performed over a 6-month follow-up period. Outcome measures included the Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) impairment scale, and radiological parameters.

Results: Among 60 patients, 38 were male, and 22 were female, with a mean age of 33.37 ± 12.26 years. The most common injury mechanisms were falls from heights (85 %). Group I had the lowest estimated blood loss (395 ± 36.20 ml) and shortest surgery duration (140 ± 26.56 min), while Group III had the highest blood loss (744.25 ± 113.69 ml) and longest surgery duration (203.50 ± 23.40 min). No statistically significant differences were observed in kyphosis correction, canal clearance, or fusion status among the groups. Neurological and functional outcomes improved across all groups, with no significant intergroup differences.

Conclusion: All three posterior instrumentation constructs provided effective management of thoracolumbar burst fractures, demonstrating high rates of fusion, significant kyphosis correction, and minimal loss of alignment. Despite variations in surgical parameters such as estimated blood loss and surgery duration, the clinical and radiological outcomes were comparable.

Level of evidence: III.

Keywords: Comparative study; Instrumentation constructs; Posterior instrumentation; Spine surgery; Surgical outcome; Thoracolumbar burst fractures.