Short segment fixation of thoracolumbar burst fractures without fusion

There continues to be controversy surrounding the management of thoracolumb ar burst fractures. Numerous methods of fixation have been described fur th is injury, but to our knowledge, spinal fusion has always been part of the stabilising procedure, whether this involves an anterior or a posterior app roach. Apart from an earlier publication from this centre, there have been no reports on the use of internal fixation without fusion for this type of fracture. The aim of the study was to determine the outcome of patients wit h thoracolumbar burst fractures who were treated with short segment pedicle screw fixation without fusion. This is a retrospective review of 28 consec utive patients who had short segment pedicle screw fixation of thoracolumba r burst fractures without fusion performed between 1990 and 1993. All patie nts underwent a clinical and radiological assessment by an independent obse rver. Outcome was measured using the Low Back Outcome Score. The minimum fo llow-up period was 2 years (mean 3.1 years). Fifty percent of patients achi eved an excellent result with the Low Back Outcome Score, while 12% were as sessed as good, 20% fair and 16% obtained a poor result. The only significa nt factor affecting outcome was the influence of a compensation claim (P < 0.05). The implant failure rate (14% of patients) and the clinical outcome was similar to that from series where fusion had been performed in addition to pedicle screw fixation. The results of this study support the view that posterolateral bone grafting is not necessary when managing patients with thoracolumbar burst fractures by short segment pedicle screw fixation.