A Comparison of 2 Surgical Treatments for Thoracolumbar Burst Fractures: Temporary Osteosynthesis and Arthrodesis

Abstract

BACKGROUND: We compared the clinical and radiological outcomes and complications of patients treated for thoracolumbar burst fractures via temporary percutaneous osteosynthesis or open definitive arthrodesis.

METHODS: A retrospective case-control study was performed including patients treated between 2017 and 2019 for a burst fracture of the thoracolumbar junction, either with percutaneous osteosynthesis (case group) or open arthrodesis (control group). Clinical, functional, and radiographic results were analyzed and compared between treatment groups.

RESULTS: We included 112 patients (56 osteosynthesis/ 56 arthrodesis, P = 1) in our study. The mean follow-up and mean age were 20 +/- 3 months (20 +/- 2/20 +/- 3, P = 1), and 41 +/- 10 years (40 +/- 11/42 +/- 10, P = 0.3), respectively. Fracture level was L1/L2 in 75% and T11/T12 in 25% of patients. The osteosynthesis group showed significantly shorter operative times (104 +/- 20 minutes/ 176 +/- 18 minutes, P < 0.01) and inpatient stays (11.6 +/- 1.5 days/15.6 +/- 3.8 days, P < 0.01). Both groups showed similar correction over kyphosis angle at final follow-up (5.8 degrees +/- 2.8 degrees/6 degrees +/- 0.2 degrees P = 0.57), but the osteosynthesis group showed increased segment mobility after hardware removal (3.8 degrees +/- 1.2 degrees/0.9 degrees +/- 0.3 degrees , P < 0.01). There were no significant differences in complications, although the osteosynthesis group showed a significantly lower need for blood transfusion (21%/43%, P = 0.02).

CONCLUSIONS: Both methods of treatment yielded good clinical and radiological results with similar complication rates. Temporary osteosynthesis seems to be more beneficial than open arthrodesis because it requires shorter operative time and hospitalization, causes less bleeding, and facilitates spinal movement.