Treatment of Multiple Thoracolumbar and Lumbar Spine Fractures: Comparison of Contiguous and Non-Contiguous Fractures in Non-Osteoporotic Patients

ABSTRACT

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the outcomes of multiple thoracolumbar and lumbar fractures depending on whether the fractures were contiguous. SUMMARY OF THE LITERATURE REVIEW: The treatment of multiple spine fractures in patients without osteoporosis has rarely been reported. MATERIALS AND METHODS: From February 2004 to January 2016, 81 patients without osteoporosis who had acute thoracolumbar and lumbar fractures and underwent posterior fusion surgery were evaluated. Patients were divided into 2 groups (group A: contiguous, group B: non-contiguous). We investigated the causes of the injuries, the locations of the injuries within the spine, the range of fusion levels, and functional outcomes based on the patients' general characteristics. RESULTS: Group A comprised 37 patients and group B comprised 44 patients. In most patients, the fusion included 3 segments (group A: 12, group B: 14) or 4 segments (group A: 9, group B: 10). Group A scored 21.2 and group B scored 19.0 on the Korean Oswestry Disability Index. In both groups, longer fusion was associated with poorer clinical results. In the clinical evaluation of the fusion rate, there was no statistically significant difference between the 2 groups (p=0.446). CONCLUSIONS: In this study, patients with multiple vertebral fractures showed more fusion segments and poor clinical outcomes in contiguous fractures. In the patients with non-contiguous fractures, the clinical results were better when a minimal number of segments was fused. Therefore, the authors recommend conservative treatment to minimize the number of segments that are fused in non-contiguous multiple thoracolumbar and lumbar fractures when decompression is not necessary.