Loss of Correction in Thoracolumbar Junction Fractures with Posterior Fusion

A retrospective study evaluated clinical and radiological results of the patiens with thoracolumbar junction fractures who were operated with posterior instrumentation. Method: In this study, the loss of correction in 20 consecutive patients who underwent posterolateral spinal fusion with Alici instrumentation for unstable thoracolumbar junction fractures was investigated. According to the outcome of the operations, patients were divided into two groups. The first group comprised those patients (12 patients= 60 %) in whom screws were successfully and correctly inserted and the second included the ones (8 patients, 40 %) with incorrectly inserted screws. Radiological evaluation was done by measuring anterior height loss (AHL), kyphotic angle (KA) and sagittal index (SI) from conventional lateral radiography, also spinal canal occupation (SCO) from computerized tomography scans pre and postoperatively. Results: There was statistically significant difference between postoperative AHL values of group 1 and group 2 (early postoperative value p<0.05, late postoperative value p<0.01) and also between early and late postoperative values in both groups (p<0.0001). Although there was no difference between two groups’ early postoperative KA and SI values (p>0.05) late postoperative values (p<0.05) were different. On the other hand no statistically significant difference was demonstrated between two groups’ postoperative SCO values (p>0.05). All the patients except three, returned to their jobs following the operation. We have observed solid fusion both clinically and radiologically in all patients. Two patients have developed complications, one had a cerebrospinal fluid fistula, which later resolved spontanously and the other had serious infection and which required removal of the instrumentation. Conclusion: Posterolateral fusion is recommended to provide original sagittal contour. In long term, functional recovery of patients may favour the surgical option for the treatment of these fractures, despite significant statistical difference between two groups in respect of loss of correction.