Fusion May Not Be a Necessary Procedure for Surgically Treated Burst Fractures of the Thoracolumbar and Lumbar Spines

• Published in: Journal of bone and joint surgery. American volume 2014-10, Vol.96 (20), p.1724-1731
• Main Authors: Chou, Po-Hsin, Ma, Hsiao-Li, Wang, Shih-Tien, Liu, Chien-Lin, Chang, Ming-Chau, Yu, Wing-Kwong
• Format: Article
• Language: English
• ISSN: 0021-9355
• DOI: 10.2106/JBJS.M.01486

Background:The surgical results of treating thoracolumbar and lumbar burst fractures were reported to be comparable between patients with and without fusion in an intermediate-term follow-up. To our knowledge, no prior report has compared the results of fusion and non-fusion with long-term follow-up.Methods:This study was designed to provide long-term evaluation of patients with a burst fracture of the thoracolumbar and lumbar spine treated with short-segment fixation who were randomly assigned to a fusion or non-fusion group. Patients older than sixty years of age at the time of injury and those who were lost to follow-up were excluded. Functional outcomes were evaluated using the Greenough Low-Back Outcome Score and the visual analog scale for back pain. Radiographic outcomes were focused on the vertebral body height of the injured vertebra, the kyphotic angle, and the regional segmental motion.Results:Twenty-two patients were enrolled in the non-fusion group, and twenty-four patients were enrolled in the fusion group. The average follow-up period was 134 months (range, 121 to 161 months). The average preoperative kyphotic angle was 16.4 degree for the non-fusion group and 19.5 degree for the fusion group. The average postoperative kyphotic angle was 1.5 degree for the non-fusion group and 4.0 degree for the fusion group. At the time of the latest follow-up, the average kyphotic angle was 13.8 degree for the non-fusion group and 14.7 degree for the fusion group. The average kyphotic angle between the two groups was similar at all follow-up times. A progressive decrease of the kyphotic angle was significant (p < 0.05) with time, regardless of fusion. The radiographic outcomes were similar between these two groups at all follow-up times, as were functional outcomes. More patients in the non-fusion group underwent additional surgery to remove implants. Regional segmental motion was preserved in the non-fusion group, with a mean motion (and standard deviation) of 4.2 degree plus or minus 1.9 degree .Conclusions:The long-term results of short segmental fixation with and without fusion for burst fractures of the thoracolumbar and lumbar spine were comparable. Regional segmental motion could be preserved without fusion, and bone graft donor site complications could be eliminated.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.