Factors associated with radiographic and clinical outcomes after posterior long-segment instrumentation for neurologically intact thoracolumbar fractures: a single-center retrospective study.
- 1Department of Orthopaedics and Traumatology, Izmir City Hospital, İzmir-Türkiye.
- 2Department of Orthopaedics and Traumatology, Ege University Faculty of Medicine, İzmir-Türkiye.
Abstract
Background
This study aimed to quantify radiographic correction and long-term maintenance, assess pain and health-related quality of life, and identify factors associated with outcomes after standardized posterior long-segment fixation for neurologically intact traumatic thoracolumbar junction fractures.Methods
This single-center retrospective cohort study included consecutive adults with acute traumatic T11-L2 fractures treated between March 2014 and February 2023 with posterior long-segment pedicle screw instrumentation (two levels above and two levels below, including fracture-level screws) without decompression. Patients required at least 24 months of radiographic follow-up, available pre-operative sagittal computed tomography images, and early post-operative and final lateral radiographs. Imaging parameters were vertebral compression angle (VCA) and anterior/posterior vertebral corpus height. Clinical outcomes were final Visual Analog Scale (VAS) and 36-item short form health survey (SF-36) scores, which were assessed cross-sectionally at final follow-up and therefore reflect final health status rather than change from pre-operative levels. Paired comparisons were used for longitudinal imaging changes, and multivariable linear regression with robust standard errors was used to evaluate factors associated with final outcomes.Results
Seventy-eight patients were included (mean age 40.2±13.9 years; 65.4% male), with a median follow-up of 48 months. VCA changed from 11.75° (7.83-16.48) preoperatively to 4.30° (2.55-6.65) early postoperatively and was 6.00° (4.00-8.80) at final follow-up, indicating limited correction loss over time. Restoration of both anterior and posterior vertebral body heights was observed, with partial loss at final follow-up. Final pain levels were low (VAS 1 [interquartile range=1-1]). In adjusted analyses, AO fracture type was associated with greater VCA loss and poorer SF-36 scores across several domains, particularly for AO type C fractures. However, the number of type C fractures was limited (n=9). Superficial wound infection occurred in 5 patients (6.4%) and resolved with local care and antibiotics; no deep infection, implant failure, revision surgery, or junctional complications were observed.Conclusion
Posterior long-segment fixation for neurologically intact T11-L2 fractures provided substantial early radiographic correction with generally limited long-term loss of alignment and low final pain levels. Nevertheless, radiographic correction did not necessarily translate into complete functional recovery, as reflected by persistent variability in SF-36 domains. Among the variables analyzed, AO fracture type showed the most consistent association with correction loss and patient-reported outcomes. These hypothesis-generating findings suggest that fracture morphology may be associated with outcomes and may help frame post-operative expectations and follow-up discussions in similar patient populations. However, confirmation in larger, prospective, and comparative studies is required.
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BibTeX
@article{suer2026factors,
title = {{Factors associated with radiographic and clinical outcomes after posterior long-segment instrumentation for neurologically intact thoracolumbar fractures: a single-center retrospective study.}},
author = {Onur Suer and Anıl Murat Ozturk},
journal = {Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma \& emergency surgery : TJTES},
year = {2026},
month = oct,
doi = {10.14744/tjtes.2026.98448},
url = {https://europepmc.org/article/MED/42841899},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Factors associated with radiographic and clinical outcomes after posterior long-segment instrumentation for neurologically intact thoracolumbar fractures: a single-center retrospective study.
AU - Onur Suer
AU - Anıl Murat Ozturk
PY - 2026
DA - 2026/10/01
JO - Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES
DO - 10.14744/tjtes.2026.98448
UR - https://europepmc.org/article/MED/42841899
AB - Background This study aimed to quantify radiographic correction and long-term maintenance, assess pain and health-related quality of life, and identify factors associated with outcomes after standardized posterior long-segment fixation for neurologically intact traumatic thoracolumbar junction fractures.Methods This single-center retrospective cohort study included consecutive adults with acute traumatic T11-L2 fractures treated between March 2014 and February 2023 with posterior long-segment pedicle screw instrumentation (two levels above and two levels below, including fracture-level screws) without decompression. Patients required at least 24 months of radiographic follow-up, available pre-operative sagittal computed tomography images, and early post-operative and final lateral radiographs. Imaging parameters were vertebral compression angle (VCA) and anterior/posterior vertebral corpus height. Clinical outcomes were final Visual Analog Scale (VAS) and 36-item short form health survey (SF-36) scores, which were assessed cross-sectionally at final follow-up and therefore reflect final health status rather than change from pre-operative levels. Paired comparisons were used for longitudinal imaging changes, and multivariable linear regression with robust standard errors was used to evaluate factors associated with final outcomes.Results Seventy-eight patients were included (mean age 40.2±13.9 years; 65.4% male), with a median follow-up of 48 months. VCA changed from 11.75° (7.83-16.48) preoperatively to 4.30° (2.55-6.65) early postoperatively and was 6.00° (4.00-8.80) at final follow-up, indicating limited correction loss over time. Restoration of both anterior and posterior vertebral body heights was observed, with partial loss at final follow-up. Final pain levels were low (VAS 1 [interquartile range=1-1]). In adjusted analyses, AO fracture type was associated with greater VCA loss and poorer SF-36 scores across several domains, particularly for AO type C fractures. However, the number of type C fractures was limited (n=9). Superficial wound infection occurred in 5 patients (6.4%) and resolved with local care and antibiotics; no deep infection, implant failure, revision surgery, or junctional complications were observed.Conclusion Posterior long-segment fixation for neurologically intact T11-L2 fractures provided substantial early radiographic correction with generally limited long-term loss of alignment and low final pain levels. Nevertheless, radiographic correction did not necessarily translate into complete functional recovery, as reflected by persistent variability in SF-36 domains. Among the variables analyzed, AO fracture type showed the most consistent association with correction loss and patient-reported outcomes. These hypothesis-generating findings suggest that fracture morphology may be associated with outcomes and may help frame post-operative expectations and follow-up discussions in similar patient populations. However, confirmation in larger, prospective, and comparative studies is required.
SN - 1306-696X
SN - 1307-7945
ER -