Thoracolumbar junction fracture and long instrumented fusion, a trial on a standardized surgical technique with long term clinical outcomes

Aim

To investigate the role of fusion construct properties, vertebral column reconstruction (VCR) techniques, steroid therapy, laminectomy versus ligamentotaxis in treatment of thoracolumbar junction fractures (TLJF).

Methods

A non-randomized clinical trial was conducted. All the eligible patients with TLJF (T12-L2) were operated with a standardized long fusion protocol and followed. Fusion rate, hardware failure, sagittal imbalance and functional outcome were identified as the primary outcome. P < 0.05 was defined as significant.

Results

Ninety-nine long fusions were reviewed in the final analysis. The mean age was 35.7 ± 13.80 years with 79.8 % male predominance. Fifty-eight percent of the patients were neurological intact. Fifty-six percent underwent concurrent laminectomy and VCR using autografts while the remaining 43.4 % received ligamentotaxis. The patients follow up (median = 25 months) showed 93.9 % solid fusion rate, 70.7 % activity independency, 1% hardware failure, 10.1 % sagittal imbalance and 4 % wound complications. Sagittal imbalance was associated with steroid therapy (p = 0.006), laminectomy (p = 0.003) and preoperative neurological deficits (p = 0.0001) and age (p = 0.049). Interestingly, Steroid therapy was associated with improved neurological and functional outcomes in impaired patients (p < 0.05). Laminectomy was associated with favorable functional outcome (OR = 9.7, CI: 2.09–45.67).

Conclusion

Our standardized long fusion protocol was associated with significant outcomes with low morbidities. Autograft mixture yield to a robust union in and over fusion construct. Methylprednisolone therapy in non-intact patients was associated with improved clinical outcomes but simultaneously, has negative impact on sagittal imbalance. Laminectomy and steroid therapy should be carefully considered in impaired patients due to their negative impact on sagittal balance.