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Chirurgia 2018 December;31(6):219-24

DOI: 10.23736/S0394-9508.18.04757-5


lingua: Inglese

Comparison between long segment and short segment posterior fixation fusion method in patients with traumatic thoracholumbar fracture

Reza BAHRAMI 1 , Saleh RASRAS 1, Mohammad GHANAVATIAN 1, Ehsan AKBARI 1, Saeed HESAM 2

1 Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran


BACKGROUND: High frequency of thoracholumbar fractures, especially among the youth in the society calls for more effective treatments. Posterolateral fixation fusion has been known as the superior method in recent decades and attempts have always been made to reduce the reduction of natural spinal cord movement involving the least number of vertebras in fixation fusion and consequently improve the quality of life, which has been achieved to a great extent by pedicle screws. On the other hand, it seems that by reducing the length of fixation, especially in thoracholumbar area which is the most prevalent area for traumatic fractures of the spinal cord, complications such as filler construct and local kyphosis will appear in long time. This study compared long segment (five verbetras and more) and short segment (four levels and less) thoracholumbar fixation fusion surgery and evaluated sagittal index and kyphosis correction loss >10 degrees as the criteria of local kyphosis and LBOS as an index of the ability for daily activities in long follow-ups.
METHODS: This cross-sectional study was conducted on 92 patients with traumatic thoracholumbar spinal cord fracture who underwent short segment or long segment posterior fusion and fixation over 2011-2015 according to indexations and patient conditions and those who lacked exclusion criteria (hemodynamic instability, multiple traumatic system, a drop in the level of consciousness before and/or after the surgery in the form of stability, old or recent traumatic neural defects, stable decrease in the level of consciousness before and/or after surgery, old recent traumatic neural defect, severe background diseases, multi-level fractures, incomplete file records and previous experience of spinal surgery). The patients’ demographic information including age, gender, fracture location and severe background diseases will be extracted from the patients’ profile and recorded. Information related to the evaluation of spinal cord including sagittal index (according to the reference) and the level of correlation loss will be calculated and recorded according to the next evaluations and over routine outpatient visits and by thoracholumbar graph and LBOS and LBOS questionnaire information. All patients’ information will enter the previously prepared questionnaire and then the version 18 of the software. Then, they will be analyzed and described.
RESULTS: In this study, long segment therapy yielded better results for instable fractures of thoracholumbar area in terms of correlation loss >degree 10. In addition, they accompanied better sagittal indices in postop and follow-up. Clinically and in terms of patients’ functions of LBOS, better results were yielded in this method than by short segment treatment.
CONCLUSIONS: Long segment posterior fixation fusion surgery is the preferred treatment for instable thoracholumbar traumatic fractures.

KEY WORDS: Fracture fixation - Surgery - Therapy

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