Turkish Neurosurgery
Comparison of two segment combined instrumentation and fusion versus three segment posterior instrumentation in thoracolumbar burst fractures; a randomized clinical trial with 10 years of follow up
Gurkan Gumussuyu1, Nazir Cihangir Islam2, Ozkan Kose3, Mutlu Gungor4, Hakan Ozcan5
1Bahçelievler Medicalpark Hospital, Orhtopaedics and Traumatologie, Istanbul,
2Kafkas University Medical Faculty, Orhtopaedics and Traumatologie, Kars,
3Antalya Training and Research Hospital, Orhtopaedics and Traumatologie, Antalya,
4Esnaf Hospital, Orhtopaedics and Traumatologie, Mugla,
5Ordu University Medical Faculty, Orhtopaedics and Traumatologie, Ordu,
DOI: 10.5137/1019-5149.JTN.25025-18.3

Aim:The aim of this randomized controlled trial was to compare the clinical and functional outcomes between combined anterior and posterior 2-segment spinal fusion and posterior 3-segment spinal fusion in patients with thoracolumbar (TL) burst fractures without neurological deficit.Material and Methods:Twenty-seven patients with TL burst fracture, >20° kyphosis/50% collapse, and posterior ligament injury, but without neurological deficit, were randomly assigned into posterior and combined groups. At the final follow-up, the clinical and functional means of the groups were compared. Results:Fourteen and 13 patients were treated with the combined and posterior approach, respectively. Age (40.0±10.3 and 37.0±14.2 years; P=.519), sex (female/male, 3:10 and 5:9; P=.385), mechanism of injury (P=.513), fractured levels (P=.185), type of fracture (P=.293), degree of kyphosis at initial admission (P=.616), collapse (P=.155), canal narrowing (P=.280), follow-up (P=.076) and accompanied limb fracture (P=.374) were similar between groups. Duration of hospital stay was similar between groups (P=.102). However, blood loss was was higher in combined group (195ml versus 358ml, P=0.003). A 14.2° correction was achieved in the posterior group and 16.9° in the combined group (P=.61). Loss of correction at the last follow-up visit was 2.1° with a final kyphosis of 7.2° in the posterior group and 1.2° with a final kyphosis of 5.5° in the combined group. The differences in the correction of kyphosis (P=.616), postop kyphosis (P=.756), loss of correction (P=.141) and final kyphosis (P=.085) between the treatment groups were not significant. At the last follow-up visit scores were similar.Conclusion:Both treatment methods are similar in terms of clinical and functional outcomes.

Corresponding author : Gurkan Gumussuyu