Short segment pedicle screw fixation is the most common treatment for thoracolumbar fractures. However, it may not be adequate to achieve and maintain reduction of the fracture and is associated with a high rate of failure. Additional procedures have been offered as alternative solutions to prevent this failure. Long segmental instrumentation or placements of screws at fracture site are some alternatives. Correction of sagittal deformity is important for the maintenance of fracture reduction and may have an effect on functional outcome. Intraoperative correction of sagittal deformity and fracture reduction can be managed easily through placement of screws at the fracture level.

The purpose of this retrospective study was to evaluate the efficacy of screw placement at the fracture level in correction of deformity, maintenance of correction and preventing the failure of fixation in thoracolumbar fractures.

Retrospective study of patients with thoracolumbar fractures treated with 4 or 6-screw construct. Preoperative, postoperative and follow-up were evaluated. To evaluate the efficacy of fracture level screw fixation anterior vertebral height compression (%ABC), local kyphosis (KA) and load-sharing classification were compared. %ABC was calculated by using the formula adopted by Mumford et al. Local kyphosis was measured according to Cobb's method. Student t test was used for statistical analysis of variables. A p-value<0.05 was considered statistically significant.

The load-sharing classification was similar between the groups. The preoperative KA was statistically similar between groups (P=0.552). The percentage of KA correction was lowest in the 4-screw construct group (P=0.034). During follow-up, KA correction was more maintained in 6-screw construct group (P=0.045). The average preoperative %ABC was similar in groups (P=0.855). %ABC was more maintained in 6-screw construct group during follow-up.

Segmental fixation of fractures with screws at the level of fracture offers improved biomechanical stability and provides for additional fixation points that may aid in reduction. The 6-screw construct yields excellent results with a very low rate of failure.