Arumugam Thirumurugan, Ramachandran Karthik, Shetty Ajoy Prasad, Kanna Rishi Mugesh, Rajasekaran Shanmuganathan
Department of Spine Surgery, Ganga Hospital, Coimbatore, India.
Asian Spine J. 2025 Jul 25. doi: 10.31616/asj.2025.0027.
A prospective randomized study.
To investigate the impact of intermediate pedicle screw length on radiological and functional outcomes in unstable thoracolumbar burst fractures (TLF) treated with short-segment posterior fixation (SSPF).
Although intermediate screws confer biomechanical advantages, there is no consensus on the ideal intermediate screw length.
Sixty-six patients with unstable TLF (Load Sharing Classification score ≥7) and normal neurology requiring SSPF were randomized into two groups. Group 1 (long intermediate screw [LIS]) underwent SSPF with a long intermediate screw (occupying >50% of the vertebral body, length ≥40 mm), while group 2 (short intermediate screw [SIS]) received a short intermediate screw (occupying <50% of the vertebral body, length ≤35 mm). Radiological parameters (restoration of anterior body height [ABH], posterior body height [PBH], ABH/PBH ratio, local kyphosis angle [LKA], and regional kyphosis angle [RKA]) and functional parameters (Visual Analog Scale score and Oswestry Disability Index) were evaluated.
Demographic variables (age, sex), mode of injury, and fracture pattern were comparable between groups. The LIS group showed a significant improvement in RKA correction in the immediate postoperative period (p =0.019), but this difference was not sustained at the final follow-up (p =0.713). Other radiological and functional parameters were comparable between the two groups at the 2-year follow-up.
Although long intermediate pedicle screw provided better correction of regional kyphosis in the immediate postoperative period for unstable TLFs with LSC ≥7, the outcomes were comparable between both long and short intermediate pedicle screws at longterm follow-up.
一项前瞻性随机研究。
探讨短节段后路固定（SSPF）治疗不稳定型胸腰椎爆裂骨折（TLF）时，中间椎弓根螺钉长度对影像学和功能结果的影响。
尽管中间螺钉具有生物力学优势，但对于理想的中间螺钉长度尚无共识。
66例不稳定型TLF（载荷分担分类评分≥7）且神经功能正常、需要进行SSPF的患者被随机分为两组。第1组（长中间螺钉[LIS]组）采用长中间螺钉进行SSPF（占据椎体>50%，长度≥40mm），而第2组（短中间螺钉[SIS]组）采用短中间螺钉（占据椎体<50%，长度≤35mm）。评估影像学参数（椎体前缘高度[ABH]、椎体后缘高度[PBH]、ABH/PBH比值、局部后凸角[LKA]和区域后凸角[RKA]）和功能参数（视觉模拟评分和Oswestry功能障碍指数）。
两组间的人口统计学变量（年龄、性别）、损伤方式和骨折类型具有可比性。LIS组术后即刻RKA矫正有显著改善（p = 0.019），但在末次随访时这种差异未持续存在（p = 0.713）。在2年随访时，两组的其他影像学和功能参数具有可比性。
尽管对于LSC≥7的不稳定型TLF，长中间椎弓根螺钉在术后即刻能更好地矫正区域后凸，但长期随访时，长、短中间椎弓根螺钉的结果具有可比性。
