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Background <p>Posterior pedicle screw instrumentation is usually used for patients with thoracolumbar burst fractures. Some scholars have suggested that pedicle fixation at the level of the fracture to improve stability, prevent postoperative loss of correction and reduce the risk of internal fixation failure. However, for patients with a load sharing classification (LSC) score ≤ 6, whether additional screws are needed in the fractured vertebra is unknown, and there is no standard treatment plan. In this prospective randomized controlled study, the imaging parameters and clinical outcomes before surgery were compared with those after surgery and during the follow-up period.</p> Methods <p>In this study, patients were randomly divided into the posterior short-segment pedicle fixation with injured vertebra fixation (PSPFI) group and the posterior short-segment pedicle fixation (PSPF) group using a digital randomization sequence. Clinical and radiographic parameters were evaluated before surgery, after surgery and at the follow-up. The imaging parameters included intervertebral disc height (IDH), anterior vertebra height (AVH), the Cobb angle (Cobb), and loss of the corrected AVH (AVH loss) and Cobb angle (Cobb loss). The Oswestry Disability Index (ODI) score and visual analog scale (VAS) score were recorded as parameters for evaluating clinical outcomes.</p> Results <p>A total of 150 patients met the inclusion criteria (75 patients each in the PSPFI and PSPF groups). There were no significant differences in the demographics between the two groups. PSPFI was superior to PSPF in the level of correction maintained. PSPF was superior to PSPFI in terms of short-term postoperative correction. However, there was no significant difference between the groups. Moreover, the differences in the VAS and ODI scores were not significant. But the PSPF group had a shorter operation time (P 0.001) and a lower blood loss (P 0.002).</p> Conclusion <p>The effect of posterior pedicle screw internal fixation for thoracolumbar fractures is good, with or without the use of intermediate screws, and there is no significant difference in the long-term follow-up data. Owing to its short operation time and low intraoperative blood loss, short-segment pedicle fixation without injured vertebra fixation is worthy of widespread application in clinical practice. </p>

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Whether patients with load sharing classification (LSC) score ≤ 6 need the additional screws in the fractured vertebra?: a prospective randomized study with 2 years of follow up

  • 期刊论文

  • 发表日期：

    2025年12月26日

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  • Yanlin Chen,
  • Wenming Zhang,
  • Haiwei Ma,
  • Jiawei Fang,
  • Shijie Liu,
  • Zhenzhong Chen,
  • Chao Lou,
  • Hehuan Lai,
  • Ye Zhu,
  • Dengwei He

摘要

Background

Posterior pedicle screw instrumentation is usually used for patients with thoracolumbar burst fractures. Some scholars have suggested that pedicle fixation at the level of the fracture to improve stability, prevent postoperative loss of correction and reduce the risk of internal fixation failure. However, for patients with a load sharing classification (LSC) score ≤ 6, whether additional screws are needed in the fractured vertebra is unknown, and there is no standard treatment plan. In this prospective randomized controlled study, the imaging parameters and clinical outcomes before surgery were compared with those after surgery and during the follow-up period.

Methods

In this study, patients were randomly divided into the posterior short-segment pedicle fixation with injured vertebra fixation (PSPFI) group and the posterior short-segment pedicle fixation (PSPF) group using a digital randomization sequence. Clinical and radiographic parameters were evaluated before surgery, after surgery and at the follow-up. The imaging parameters included intervertebral disc height (IDH), anterior vertebra height (AVH), the Cobb angle (Cobb), and loss of the corrected AVH (AVH loss) and Cobb angle (Cobb loss). The Oswestry Disability Index (ODI) score and visual analog scale (VAS) score were recorded as parameters for evaluating clinical outcomes.

Results

A total of 150 patients met the inclusion criteria (75 patients each in the PSPFI and PSPF groups). There were no significant differences in the demographics between the two groups. PSPFI was superior to PSPF in the level of correction maintained. PSPF was superior to PSPFI in terms of short-term postoperative correction. However, there was no significant difference between the groups. Moreover, the differences in the VAS and ODI scores were not significant. But the PSPF group had a shorter operation time (P 0.001) and a lower blood loss (P 0.002).

Conclusion

The effect of posterior pedicle screw internal fixation for thoracolumbar fractures is good, with or without the use of intermediate screws, and there is no significant difference in the long-term follow-up data. Owing to its short operation time and low intraoperative blood loss, short-segment pedicle fixation without injured vertebra fixation is worthy of widespread application in clinical practice.