Short Segment Versus Long Segment Transpedicular Screw Fixation in the Correction and Preservation of AO-Type B Thoracolumbar Fracture Alignment: A Comparative Study

Short Segment Versus Long Segment Transpedicular Screw Fixation in the Correction and Preservation of AO-Type B Thoracolumbar Fracture Alignment: A Comparative Study. To Compare the Radiological, Clinical and Functional Outcomes of Short-segment Versus Long-segment Transpediclular Screw Fixation in Patients With Thoracolumbar Fractures AO-type B.

To compare the radiological, clinical and functional outcomes of short-segment versus long-segment transpediclular screw fixation in patients with thoracolumbar fractures AO-type B.

Thoracolumbar fractures represent the most common spinal injuries, predominantly occurring at the T11-L2 junction due to the biomechanical transition from the rigid thoracic to the mobile lumbar spine. This region accounts for approximately half of all traumatic spinal fractures, owing to changes in spinal curvature, facet joint orientation, and load-bearing mechanics (1).

Surgical management aims to restore spinal stability, correct kyphotic deformity, decompress neural elements, and enable early mobilization. Two posterior fixation strategies exist: short-segment fixation (SSF), spanning one level above and below the fracture with one or 2 intermediate screws in the fractured vertebra itself, and long-segment fixation (LSF), spanning two or more levels above and below with one or 2 intermediate screws in the fractured vertebra itself. Short-segment constructs preserve more motion segments with reduced surgical morbidity, while long-segment constructs provide potentially greater stability (2).

The optimal choice remains debated. A 2025 meta-analysis of 17 trials (1,031 patients) showed that LSF was associated with higher blood loss and longer operative time but better kyphosis correction maintenance and pain improvement (3). Short-segment fixation with intermediate screws at the fracture level has shown comparable results to LSF while preserving motion segments and reducing costs (4).

There is no randomized trial on AO-type B. Given these controversies, a prospective comparative study in our population is warranted.

Inclusion Criteria:

• Age 18-65 years
• Acute traumatic thoracolumbar fracture (AO type B)
• Single-level fracture
• Neurologically intact patient (ASIA E)

Exclusion Criteria:

• Pathological fractures (malignancy, infection, metabolic bone disease)
• Significant neurological deficit (ASIA A-D)
• Previous spinal surgery at or adjacent to the fracture level
• 2 or more level fractures
• Associated anterior column reconstruction requirement (corpectomy)
• Polytrauma precluding early spinal surgery
• Pregnancy
• Performance of surgical decompression