Many studies showed that the most common causes for spinal fractures are fall from height and road traffic accidents respectively [13, 14].
Although the thoracolumbar junction fractures constitute a major portion of spine fractures as it represents more than 54% of all spine fractures, the instrumentation of this region remains a matter of great controversy, however nowadays posterior short-segment trans-pedicular screw fixation is preferred for fixation of these fractures than long-segment fixation since it offers less operative time, less intraoperative blood loss and better preservation of motion. However, this method was associated with higher rates of implant failure and recurrence of kyphosis and pain [15]. Inclusion of the fractured level in the short-segment construct was first described by Dick et al. [8] in 1994 and this method since then has advanced to overcome these drawbacks, he concluded that adding screws at the fracture level enhanced spinal stability, provided stronger fixation and diminished stress on the remaining pedicle screws in the short-segment construct [16].
Of the thirty cases included in the study, seven patients were presented with incomplete neurological deficits (ASIA grade D & C). These patients reported improvement of the neurological state in the follow-up period as six patients improved to ASIA grade E and one patient to ASIA grade D.
Patients reported minimal to moderate disability on the Oswestry disability index after surgery. The mean ODI was 19.87%. The study of Sun et al. [17], reported similar results with mean ODI of 16.7% in the group treated with short segment-fixation including the fracture level.
Our study showed that the mean operative time was 102.17 min, while in the study done by Dobran et al. [13], the mean operative time in the long-segment fixation group was 172 min that was longer than our used method by about 70 min indicating that short segment fixation provides a time saving method better than the long-segment one. These results were in concordance with the results of Adawi et al. [18], where the mean operative time was 129.7 min.
As regarding the kyphotic angle, the current study showed a significant improvement in postoperative Cobb angle when compared to preoperative values (P ≤ 0.001) as the mean preoperative Cobb angle was 19.37° while the mean postoperative Cobb angle was 11.77°. Our results agreed with a study conducted by El Behairy et al. [19], concluded that short segment pedicle screw fixation including the fractured vertebra accomplished good correction of segmental kyphosis and maintained at the end of a 2-year study. Dobran et al. [13] showed no significant difference between short-segment fixation including fractured level and long-segment fixation in kyphosis correction and maintenance. While, Farrokhi et al. [20] showed that correction of kyphosis was better achieved with short-segment fixation including the fractured level than short-segment fixation excluding the fractured level.
In our study, measurement of the vertebral body height showed that there was significant restoration of vertebral body height after fixation. The mean preoperative anterior and posterior vertebral body height were 15.18 mm and 19.41 mm respectively. These values improved to be 18.04 mm and 21.31 mm respectively at the end of the follow-up period. This was supported by the study of Kanna et al. [21] that showed significant restoration of vertebral body height which was maintained till the end of the follow-up period as they found that the mean preoperative anterior vertebral body height was 13.86 mm that improved to 21.6 mm in the immediate postoperative and to 21.1 mm at the end of the follow-up period. The study also found that the mean preoperative posterior vertebral body height was 25.7 mm that improved to 28.1 mm after surgery and to 28.1 mm at the end of the follow-up period. The study done by El Behairy et al. [19], also confirmed that with inclusion of the fractured level in the short-segment construct provided better restoration and maintenance of vertebral body height for up to 2 years after surgery.
Radiological signs of spinal fusion were assessed in the follow-up radiographs, there was no lucency around the screws in 96.7% of cases, bridging bone formation was present in 93.3% of cases and there was no displacement or breakage of screws. Despite being popular, posterior short-segment fixation has its drawbacks including higher rates of implant failure than long-segment fixation and loss of kyphosis correction over time. An alternative method is including the fracture level in the short-segment construct. This method provides fewer rates of implant failure and recurrence of kyphosis. This was supported by a study conducted by Mahar et al. [9] reported increased biomechanical stability using this technique. Also the studies of Guven et al. [10] and Bolesta et al. [16] showed increased stability and maintained kyphosis correction when inclusion of fracture level was used.