www.jkns.or.kr http://dx.doi.org/10.3340/jkns.2012.52.4.346 J Korean Neurosurg Soc 52 : 346-352, 2012 Print ISSN 2005-3711 On-line ISSN 1598-7876 Copyright © 2012 The Korean Neurosurgical Society Clinical Article Comparison of Posterior Fixation Alone and Supplementation with Posterolateral Fusion in Thoracolumbar Burst Fractures Jong-Uk Hwang, M.D., Jin-Woo Hur, M.D., Jong-Won Lee, M.D., Ki-Young Kwon, M.D., Hyun-Koo Lee, M.D., Ph.D. Department of Neurosurgery, Cheongju St. Mary’s Hospital, Cheongju, Korea Objective : We compared the radiological and clinical outcomes between patients who underwent posterior fixation alone and supplemented with fusion following the onset of thoracolumbar burst fractures. In addition, we also evaluated the necessity of posterolateral fusion for patients treated with posterior pedicle screw fixation. Methods : From January 2007 to December 2009, 46 consecutive patients with thoracolumbar burst fracture were included in this study. On the basis of posterolateral fusion, we divided our patients into the non-fusion group and the fusion group. The radiological assessment was performed according to the Cobb’s method, and results were obtained at immediately, 3, 6, 12 months after surgery. The clinical outcomes were evaluated us- ing the modified Mcnab criteria at the final follow-up. Results : The demographic data and the mean follow-up period were similar between the two groups. Patients of both groups achieved satisfactory clinical outcomes. The mean loss of kyphosis correction showed that patients of both groups experienced loss of correction with no respect to whether they underwent the posterolateral fusion. There was no significant difference in the degree of loss of correction at any time points of the follow-up between the two groups. In addition, we also compared the effect of fixed levels (i.e., short versus long segment) on loss of correction be- tween the two groups and there was no significant difference. There were no major complications postoperatively and during follow-up period. Conclusion : We suggest that posterolateral fusion may be unnecessary for patients with thoracolumbar burst fractures who underwent posterior pedicle screw fixation. Key Words : Thoracolumbar burst fracture · Posterior pedicle screw fixation · Posterolateral fusion · Loss of kyphosis correction. INTRODUCTION The thoracolumbar spine fracture is one of the fractures that are encountered the most frequently in a clinical settings, and it is involved in almost 90% of all spinal injuries. In addition, 10% to 20% of them are burst fractures3,7,8). Some mechanical factors make the thoracolumbar spine susceptible to fracture following trauma. As a typical example, the thoracolumbar junction is a unique part of the spinal column where the spine undergoes the transition from the rigid kyphotic thoracic to mobile lordotic lumbar spine. This transitional anatomy renders it vulnerable to the trauma from a fall or a motor vehicle accident17,18,36). Thora- columbar burst fractures usually occur due to a substantial axial loading force, which results in a compression failure of the ante- rior and middle spinal columns. There are some characteristic findings in the burst fractures; comminution of the injured ver- tebral body, progressive kyphotic deformity of the sagittal align- ment, and canal compromise caused by retropulsion of the frac- ture segment, which may produce neurological deficits. The management of thoracolumbar burst fractures still re- mains a challenging issue. Treatment varies ranging from the conservative management to various types of surgery. In addi- tion, there is a great variability in the indications depending on surgeons. Furthermore, diverse treatments have been proposed for thoracolumbar burst fractures by different authors35,38). To date, many published studies have reported this issue. It re- mains unclear, however, which treatment modalities would be more effective between the conservative and surgical manage- • Received : June 13, 2012 • Revised : August 28, 2012 • Accepted : October 4, 2012 • Address for reprints : Jin-Woo Hur, M.D. Department of Neurosurgery, Cheongju St. Mary’s Hospital, 173-19 Juseong-ro, Sangdang-gu, Cheongju 360-568, Korea Tel : +82-43-219-8467, Fax : +82-43-211-7925, E-mail : somalh@naver.com • This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 346