Comparison Of The Effect Of Long-segment And Short-segment Pedicle Screw Fixation For Thoracic And Lumbar Fracture And Dislocation

Objective To compare the effect of long-segment and short-segment pedicle screw fixation for thoracic and lumbar fracture and dislocation, and discuss the relationship of the number of fixed segments and the outcome of reduction, in order to provide theoretical basis for better treatment of thoracic and lumbar fracture and dislocation.Methods The outcomes of 31 cases of thoracic and lumbar fracture and dislocation patients were analyzed retrospectively.13 cases performed long segmental fixation,18 cases performed short segment fixation. The mean follow-up time was 19.7 months. The anterior vertebral compression rate, Cobb angle, operation time, blood loss, and Frankel neurological classification were evaluated in all cases.Results All patients were followed up for 12 to 33 months, with an average of 19.7 months. The lateral and sagittal dislocations were completely corrected in 13 patients treated with long-segment fixation, and the spinal alignment was restored. One case of connecting rod fracture occurred during follow-up. The dislocations was not fully corrected in 18 patients treated with short segment fixation, and one case of pedicle screw fracture, one cases of lateral dislocation increased were occurred. After surgery, the anterior vertebral compression correction rate, Cobb angle correction rate are significantly reduced in both groups, and the long-segment group has better results. The operative time and blood loss are less in short segment group than in long segment group. The Frankel classification also improved after surgery in both groups, while no significant differences were found between two groups.Conclusion Both the long-segment and short-segment pedicle screw fixation have good outcomes in the correction of kyphosis, restore of vertebral body height, and improvement of neurological function. Although the short-segment fixation has advantages in lesser blood loss and shorter operative time, the long-segment fixation has better results in the correction of kyphosis and restore of vertebral body height, especially in the correction of severe dislocation and lateral shift. Due to our limited sample size and retrospective individual study, the effect of long-segment pedicle screw fixation exceed that of short-segment fixation need further confirmations in bio-mechanics studies and clinical observations.