The biomechanics of long versus short fixation for thoracolumbar spine fractures

Literature review. Provide an overview of biomechanical strengths and weaknesses of long and short fixation constructs applied in thoracolumbar fractures, along with a discussion of specific indications for selecting an instrumentation construct for a given fracture. Previous clinical and biomechani...

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Bibliographic Details
Published in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 2006-05, Vol.31 (11 Suppl), p.S70-S79
Main Author: McLain, Robert F
Format: Article
Language:English
Subjects:
Fracture Fixation - instrumentation
Fracture Fixation - methods
Humans
Internal Fixators
Lumbar Vertebrae - injuries
Lumbar Vertebrae - surgery
Spinal Fractures - physiopathology
Spinal Fractures - surgery
Spinal Fusion - instrumentation
Spinal Fusion - methods
Thoracic Vertebrae - injuries
Thoracic Vertebrae - surgery
Weight-Bearing
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Summary:Literature review. Provide an overview of biomechanical strengths and weaknesses of long and short fixation constructs applied in thoracolumbar fractures, along with a discussion of specific indications for selecting an instrumentation construct for a given fracture. Previous clinical and biomechanical studies have shown that segmental spinal instrumentation provides superior torsional, axial, and sagittal stability relative to nonsegmental systems. Multilevel fixation (long constructs) has proven reliable and effective in treating thoracic injuries, with or without anterior reconstruction. Short-segment pedicle instrumentation (short constructs) have proven effective in stabilizing thoracolumbar and lumbar fractures while limiting the disruption of lower lumbar motion segments. Loss of anterior column integrity leads to fixation failure when short constructs are not supplemented with further fixation or an anterior reconstruction. Review of the applicable clinical and biomechanical literature. Long constructs serve well in thoracic and thoracolumbar fractures, while short-segment fixation offers advantages in selected thoracolumbar and lumbar fractures. Anterior column integrity determines the risk of sagittal collapse and kyphosis at the thoracolumbar junction. Recognition of fundamental biomechanical principles is necessary to make either construct work reliably.
ISSN:0362-2436
1528-1159
DOI:10.1097/01.brs.0000218221.47230.dd