The use of screw at the fracture level in the treatment of thoracolumbar burst fractures

J Spinal Disord Tech. 2009 Aug;22(6):417-21. doi: 10.1097/BSD.0b013e3181870385.


Study design: In this prospective randomized study, the results of treating unstable thoracolumbar burst fractures by pedicle instrumentation with and without fracture level screw combination were given.

Objective: Our aim was to evaluate the efficacy of fracture level screw combination in achieving and maintaining correction in the treatment of unstable thoracolumbar burst fractures.

Summary of background data: Most authors reported that intraoperative correction of sagittal deformity is important for the maintenance of fracture reduction and is one of the most consistent predictor of satisfactory functional outcome.

Methods: Seventy-two patients with unstable thoracolumbar burst fractures were randomized into 4 groups with equal number of patients. In group 1, patients were treated by segmental posterior instrumentation with 2 levels above and 2 levels below the fracture level fixation, in group 2 they were treated as in group 1 with fracture level screw incorporation. In group 3, patients were treated by short-segment posterior instrumentation with 1 level above and 1 level below, in group 4 they were treated by short-segment posterior instrumentation with fracture level screw incorporation. Clinical and radiologic parameters were evaluated before surgery, after surgery, and at follow-up.

Results: The average follow-up was 50 months. Fracture level screw combination provided better intraoperative correction and maintenance in the treatment of unstable thoracolumbar burst fractures, which was more prevalent in short-segment fixation group.

Conclusions: Reinforcement with fracture level screw combination can help to provide better kyphosis correction and offers immediate spinal stability in patients with thoracolumbar burst fracture.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Activities of Daily Living
  • Adult
  • Bone Screws / statistics & numerical data*
  • Female
  • Humans
  • Internal Fixators / statistics & numerical data*
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / pathology
  • Lumbar Vertebrae / surgery*
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology
  • Postoperative Complications / prevention & control
  • Prospective Studies
  • Radiography
  • Range of Motion, Articular / physiology
  • Spinal Fractures / diagnostic imaging
  • Spinal Fractures / pathology
  • Spinal Fractures / surgery*
  • Spinal Fusion / instrumentation*
  • Spinal Fusion / methods
  • Thoracic Vertebrae / diagnostic imaging
  • Thoracic Vertebrae / pathology
  • Thoracic Vertebrae / surgery*
  • Treatment Outcome
  • Young Adult