ArticleUlusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES2025
The effect of fusion levels on clinical outcomes in traumatic lower lumbar vertebral fractures.
Article in Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFractures of the lower lumbar spine (LLS) are uncommon and present unique biomechanical challenges. This study aimed to assess and compare the clinical and radiological outcomes of short-segment posterior instrumentation (SSPI) versus long-segment posterior instrumentation (LSPI).
methodsA retrospective cohort of patients aged 18-63 years who underwent posterior instrumentation for thoracolumbar (TL, T10-L2) or LLS (L3-L5) fractures between 2005 and 2022 was analyzed. SSPI was applied for AO type A2-A4 injuries, while LSPI was reserved for type B2, B3, and C injuries. Functional outcomes were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS), while radiological alignment was evaluated with the sagittal Cobb angle (SCA). Forty-nine patients were included: 33 with thoracolumbar (TL) fractures and 16 with LLS fractures.
resultsEight LLS patients underwent SSPI, eight received LSPI, and all TL fractures were treated with SSPI. SCA improved significantly in all groups (p<0.001). In LLS fractures, LSPI resulted in worse function (ODI 40.6+-15.4 vs. 25.4+-7.2, p=0.040; VAS 3.0+-1.7 vs. 2.2+-2.4, p=0.038) compared with SSPI. Functional outcomes for LL-SSPI and TL-SSPI were comparable. SSPI achieved similar radiological correction with 19% shorter operative time and reduced blood loss.
conclusionIn this study, the SSPI method was found to be a safe option for the management of LLS fractures from both clinical and radiological perspectives. In contrast, the LSPI method should be reserved for highly unstable injuries, as it may have a detrimental effect on lumbar function.
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