Is Fusion Mandatory with Spinal Fixation of Traumatic Thoracolumbar Burst Fractures? A Prospective Comparative Study

Abstract

Study design: A prospective case series study.

Purpose:To compare the outcome in cases of traumatic thoracolumbar burst fractures surgically treated by posterior pedicle screw instrumentation with fusion versus posterior instrumentation without fusion, focusing on functional outcome, radiological outcome, intraoperative and postoperative complications.

Overview of Literature: According to the Denis three-column concept, burst fractures consist of anterior and middle columns injury with retropulsion of bony fragments into the spinal canal, which is the radiographic hallmark. Typical clinical symptoms include back pain, restricted motion and neurological impairments. Progressive kyphotic deformities are frequently seen. The ideal treatment for patients with a thoracolumbar burst fracture remains controversial. Benefit of fusion with posterior instrumentation is still questionable. Non-fusion obviates the need for bone grafting and hence reduces blood loss and operation time, preserve better segmental motion and avoid donor site complications. On the other hand, achievement of solid fusion reduces risk of re-kyphosis and implant failure.

Methods: Study was prospectively conducted on 40 patients with T10-L2 traumatic burst fractures, assigned into 2 equal groups: a fusion and a non-fusion group.

Results:Mean age of patients was 37.2 years with minimal male predominance.Fall from height was the most common mode of trauma (62.5%) followed by RTAs. T12 was the most commonly injured level followed by L1, L2 and T11, respectively. Both operative time and intraoperative blood loss were higher in the fusion group, but the difference was not statistically significant. The difference in loss of correction, loss of restored vertebral body height and VAS score between the groups after 6 months proved to be statistically insignificant. There was only one case of implant failure during our follow-up in the fusion group.

Conclusion:Both techniques achieved similar radiological and functional outcomes. There was no significant difference in implant failure rate. In addition, non-fusion avoids bone harvest complications, saves high cost of synthetic bone substitutes and reduces duration of surgery and blood loss.