Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine? A prospective, randomized study

Study Design. A prospective clinical trial was conducted. Objectives. To compare the results of fusion versus nonfusion for surgically treated burst fractures of the thoracolumbar and lumbar spine. Summary of Background Data. The operative results of surgically treated burst fractures with short segmental fixation have been well documented. There is no report comparing the results of fusion and nonfusion. Methods. Fifty-eight patients were included in this study, with the inclusion criteria as follows: neurologically intact spine with a kyphotic angle >= 20 degrees, decreased vertebral body height >= 50% or a canal compromise >= 50%, incomplete neurologic deficit with a canal compromise < 50%, complete neurologic deficit, and multilevel spinal injury or multiple traumas. All patients were randomly assigned to fusion or nonfusion groups, and operative treatment with posterior reduction and instrumentation was carried out. Posterior fusion with autogenous bone graft was performed for the fusion group (n = 30), and no fusion procedure was done for the nonfusion group (n = 28). The average follow- up period was 41 months ( range, 24 - 71 months). Results. The average loss of kyphotic angle was not statistically significant between these 2 groups. The radiographic parameters were statistically significantly better in the nonfusion group, including angular change in the flexion-extension lateral view (4.8 vs. 1.0), lost correction of decreased vertebral body height (3.6% vs. 8.3%), intraoperative estimated blood loss ( 303 mL vs. 572 mL), and operative time ( 162 minutes vs. 224 minutes). The scores on the low back outcome scale were not statistically significant for these 2 groups. Conclusions. The short-term results of short segmental fixation without fusion for surgically treated burst fractures of the thoracolumbar spine were satisfactory. The advantages of instrumentation without fusion are the elimination of donor site complications, saving more motion segments, and reducing blood loss and operative time.