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Posterior Short Segment Fixation with Index Level Screw for the Unstable Thoracolumbar Burst Fracture

Background: Thoracolumbar fracture is nearly 90% of all the spine injuries which treated by spine surgeons. The choice of the stabilization type is still the subject of controversy. In long segment fixation, the problem is that more motion segment loss is concerned. The number of motion segments involved in fusion of spine fracture is minimized by posterior short segment fixation with index level screw. Objective: The purpose of the study is to assess the ability of short segment fixation with index level screw at fracture level to correct deformity, maintain correction and prevent failure. Method: 15 patients who were operated between March 2018 and January 2021 were taken for the retrospective analysis. All patients were surgically treated with short segment fixation using a posterior surgical approach with transpedicular instrumentation. Pedicle screws were placed at one level above and below the fracture site. Additionally, pedicle screws were also inserted at the index level of the fracture. All the patients were followed up at 3 months, 6 months and 12 months postoperatively. Results: The Mean pre-operative kyphosis was 14° (range 6° to 24°). Average post-operative kyphosis was 0° (range 6° to −18°). Average follow-up kyphosis of all cases was 10° (range 0.85° to 35.00°). Excluding failures, average follow-up kyphosis was 8° (range 0.85° to 25.00°). The height of the vertebral body was maintained upto 95% in 6 patients, 80% in 6 patients, and 70% in 3 patients. At initial one-month follow-up, average Oswestry disability score was severe at 52.63% (range 16% to 84%). At most recent follow-up, average Oswestry disability score was minimal at 5.5% (range 0% to 16%). One patient was lost to long-term follow- up. Mean difference from one-month follow-up to most recent follow-up (excluding failures) was 47.27% (P < 0.0001). Conclusion: The short same-segment fixation reduces the implantation failure rate and reoperation rate in our study. Long-term correction of kyp