gms | German Medical Science

Objectives: Surgical treatment in burst fractures is recommended to establish stability and recover the sagittal and coronal deformity. Therefore, a variety of different techniques have been described including anterior stabilization and posterior fixation with or without an intermediate screw at the fractured level.

This study aims to investigate the changes in kyphotic alignment for burst fractures following anterior and posterior stabilization with or without an intermediate screw at the fractured level.

Methods: A retrospective study was conducted including all surgically treated burst fractures between 2017 and 2021. All patients with a minimum follow up of 6 months were included and classified into posterior fixation with and without an intermediate screw at the fractured level (PSF/PSFW), and anterior stabilization (AS). Demographics, number of levels fused, preoperative, immediate and at final follow up postoperative radiographic findings were analyzed. This included the section angle of the fused levels, the vertebral as well as the thoracolumbar angles were measured. Finally the change in angles were noted.

Results and conclusion: A total of 95 patients met inclusion criteria. Most patients presented with an A3 type fracture (55.3%), followed by A4 (40.2%). Posterior fixation without pedicle screws at the fracture side was performed in 52.6% (n=50/95), followed by posterior fixation with a pedicle screw at the fracture side in 32.6% (n=31/95) and anterior stabilization with expandable cage in 14.7% (n=14/95). Before surgery the vertebral angle was 11.6±8.2° with an average thoracolumbar angle of 13.2±9.7°. This changed significantly in all three groups where the best correction was observed in the PSFW group (4.8±4.0°), followed by PSF (5.4±4.7°) and AS with 8.6*6.6°. Similar findings were observed for the thoracolumbar angle (PSFW=3.8±3.6°, PSF=7.4±5.7° and AS 5.9±4.6°). At final follow up some reduction of the vertebral angle and thoracolumbar angle was lost in all groups without significance (PSFW=6.9±10.0°, respectively, 6.3±5.0°, PSF=6.5±5.7, respectively 8.0±6.9° and AS=7.4±5.9° respectively, 8.2±6.3°; all p>0.05).

Surgical management for burst fractures are still controversial to restore the kyphosis angle. Posterior stabilization with an intermediate screw at the fractured level seems to allow best reduction and minimal loss of reduction at final follow up. Even after anterior stabilization using an expandable cage loss of reduction was observed.