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Background <p>Short-segment fixation with inclusion of a screw at the fractured vertebra preserves motion segments but has been criticized for possible loss of correction. Long-segment fixation may provide more stable constructs but at the cost of greater operative time and blood loss. We compared radiographic maintenance of alignment and perioperative outcomes between these two approaches in patients with unstable thoracic and lumbar fractures.</p> Methodology <p>We conducted a single-center retrospective cohort study of adults treated with posterior instrumentation for a single unstable thoracic or lumbar fracture between January 2017 and June 2023. Patients who underwent short-segment fixation with an additional screw at the fractured level were compared with those who underwent long-segment fixation involving two levels above and two levels below without an index-level screw. The primary outcome was kyphotic angle at final follow-up. Secondary outcomes included change in alignment from baseline, vertebral height ratio (Beck index), operative time, intraoperative blood loss, blood transfusion, complications, and reoperations. Multivariable models adjusted for baseline deformity, fracture type, fracture level, surgical approach, age, and sex. Because treatment allocation was imbalanced and non-randomized, adjusted estimates were interpreted cautiously.</p> Results <p>We analyzed 176 patients, of whom 57 underwent short-segment fixation and 119 underwent long-segment fixation, with a minimum follow-up of 12&#xa0;months. After adjustment for baseline deformity, fracture classification, fracture level, surgical approach, age, and sex, final kyphotic angle did not differ significantly between groups. Differences in operative time and intraoperative blood loss were not statistically significant after adjustment. Complication and reoperation rates were low and not significantly different between groups.</p> Conclusions <p>Short-segment fixation with fracture-level inclusion was associated with radiographic outcomes that were not significantly different from long-segment fixation at 12&#xa0;months. Perioperative differences were not statistically significant after adjustment, and complication rates were low in both groups. These findings should be interpreted cautiously because treatment allocation was non-randomized and imbalanced.</p>

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Short-segment (index-level) versus long-segment pedicle screw fixation for unstable thoracic and lumbar fractures: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月20日

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  • Ali Msheik,
  • Abdullah Illeyan,
  • Omar M. Shihadeh,
  • Amr El Mohamad,
  • Muhammad Mohsin Khan,
  • Ahmad Shamtia,
  • Ahmad N. Al-Ekeer,
  • Rana A. Mohammed,
  • Abdurrahman Shihadeh,
  • Mohamed Altayeb,
  • Ghaya Al Rumaihi

摘要

Background

Short-segment fixation with inclusion of a screw at the fractured vertebra preserves motion segments but has been criticized for possible loss of correction. Long-segment fixation may provide more stable constructs but at the cost of greater operative time and blood loss. We compared radiographic maintenance of alignment and perioperative outcomes between these two approaches in patients with unstable thoracic and lumbar fractures.

Methodology

We conducted a single-center retrospective cohort study of adults treated with posterior instrumentation for a single unstable thoracic or lumbar fracture between January 2017 and June 2023. Patients who underwent short-segment fixation with an additional screw at the fractured level were compared with those who underwent long-segment fixation involving two levels above and two levels below without an index-level screw. The primary outcome was kyphotic angle at final follow-up. Secondary outcomes included change in alignment from baseline, vertebral height ratio (Beck index), operative time, intraoperative blood loss, blood transfusion, complications, and reoperations. Multivariable models adjusted for baseline deformity, fracture type, fracture level, surgical approach, age, and sex. Because treatment allocation was imbalanced and non-randomized, adjusted estimates were interpreted cautiously.

Results

We analyzed 176 patients, of whom 57 underwent short-segment fixation and 119 underwent long-segment fixation, with a minimum follow-up of 12 months. After adjustment for baseline deformity, fracture classification, fracture level, surgical approach, age, and sex, final kyphotic angle did not differ significantly between groups. Differences in operative time and intraoperative blood loss were not statistically significant after adjustment. Complication and reoperation rates were low and not significantly different between groups.

Conclusions

Short-segment fixation with fracture-level inclusion was associated with radiographic outcomes that were not significantly different from long-segment fixation at 12 months. Perioperative differences were not statistically significant after adjustment, and complication rates were low in both groups. These findings should be interpreted cautiously because treatment allocation was non-randomized and imbalanced.