The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

Objective: This paper aims to differentially depict potential patterns of the loss of correction in surgically treated thoraco-lumbar burst fractures. These may eventually serve to foreseeing and even forestalling loss of correction.
Methods: The study focused on 253 patients with surgically treated thoraco-lumbar fractures. This cohort of patients was clustered in four subgroups according to the fracture spine segment (T11–L1 or L1–L2) and surgery type (short segment fixation or anterior approach). Relevant recorded and processed data were the fracture level, post-operative (Kpo) and last follow-up (Kf) kyphosis angle values. Correlation, regression and determination testing were performed for the last follow-up kyphosis angle and post-operative kyphosis angle, and regression equations were determined for each subgroup of patients.
Results: The patterns of loss of correction were described through the following equations: Kf = 0.95*Kpo + 3.2° for the T11–L1 level fractured vertebrae treated by posterior short segment fixation; Kf = 0.98*Kpo + 3.4° for the L1–L2 level fractured vertebrae treated by posterior short segment fixation; Kf = 1.1*Kpo + 1.6° for the T11–L1 level fractured vertebrae treated by anterior approach; and Kf = 0.7*Kpo + 2.8° for the L1–L2 level fracture vertebrae treated by anterior approach.
Conclusions: The loss of correction may be predicted, to a certain extent, for thoraco-lumbar fractured vertebrae treated surgically. The best-fit equations depicted for both type of surgery (short segment fixation and anterior approach) and both spinal segments (T11–L1 and L2–L3) are significantly different than the equations delineated for the collapse of non-surgically treated fractures.