Ulus Travma Acil Cerrahi Derg. 2025; 31(10): 1003-1010 | DOI: 10.14744/tjtes.2025.44234

The effect of fusion levels on clinical outcomes in traumatic lower lumbar vertebral fractures

Halil Gok¹, Alim Can Baymurat², Asim Ahmadov², Alpaslan Senkoylu^2
1Department of Orthopaedics and Traumatology, Ankara Etlik City Hospital, Ankara-Türkiye
²Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Ankara-Türkiye

BACKGROUND: Fractures of the lower lumbar spine (LLS) are uncommon and present unique biomechanical challenges. This study aimed to assess and compare the clinical and radiological outcomes of short-segment posterior instrumentation (SSPI) versus long-segment posterior instrumentation (LSPI).
METHODS: A retrospective cohort of patients aged 18–63 years who underwent posterior instrumentation for thoracolumbar (TL, T10–L2) or LLS (L3–L5) fractures between 2005 and 2022 was analyzed. SSPI was applied for AO type A2–A4 injuries, while LSPI was reserved for type B2, B3, and C injuries. Functional outcomes were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS), while radiological alignment was evaluated with the sagittal Cobb angle (SCA). Forty-nine patients were included: 33 with thoracolumbar (TL) fractures and 16 with LLS fractures.
RESULTS: Eight LLS patients underwent SSPI, eight received LSPI, and all TL fractures were treated with SSPI. SCA improved significantly in all groups (p<0.001). In LLS fractures, LSPI resulted in worse function (ODI 40.6±15.4 vs. 25.4±7.2, p=0.040; VAS 3.0±1.7 vs. 2.2±2.4, p=0.038) compared with SSPI. Functional outcomes for LL-SSPI and TL-SSPI were comparable. SSPI achieved similar radiological correction with 19% shorter operative time and reduced blood loss.
CONCLUSION: In this study, the SSPI method was found to be a safe option for the management of LLS fractures from both clinical and radiological perspectives. In contrast, the LSPI method should be reserved for highly unstable injuries, as it may have a detrimental effect on lumbar function.

Keywords: Lower lumbar fractures, short segment fusion, long segment fusion, posterior instrumentation, Oswestry Disability Index, sagittal Cobb angle.

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Travmatik alt lomber vertebra kýrýklarýnda füzyon seviyelerinin klinik sonuçlara etkisi

Halil Gok¹, Alim Can Baymurat², Asim Ahmadov², Alpaslan Senkoylu^2
1Ankara Etlik Þehir Hastanesi, Ortopedi Ve Travmatoloji Kliniði, Ankara
²Gazi Üniversitesi Týp Fakültesi, Ortopedi Ve Travmatoloji Anabilim Dalý, Ankara

AMAÇ: Alt lomber (AL) omurga travmatik kýrýklarý nadir görülür ve özgün biyomekanik zorluklar içerir. Bu çalýþma, kýsa segment posterior enstrümantasyonun (KSPE) uzun segment posterior enstrümantasyona (USPE) kýyasla klinik ve radyolojik sonuçlarýný karþýlaþtýrmayý amaçlamaktadýr. GEREÇ VE YÖNTEM: 2005–2022 yýllarý arasýnda, 18–63 yaþ aralýðýnda olup torakolomber (TL) (T10-L2) ve AL (L3-L5) seviyelerinde kýrýk nedeniyle posterior enstrümantasyon uygulanan hastalar retrospektif olarak incelendi. Tip A2-A4 kýrýklarda KSPE, tip B2, B3 ve C kýrýklarda ise USPE tercih edildi. Fonksiyonel sonuçlar Oswestry Disabilite Ýndeksi (ODÝ) ve Vizüel Analog Skala (VAS) ile, radyolojik sonuçlar ise sagittal Cobb açýsý (SCA) ile deðerlendirildi. Toplam 49 hasta analiz edildi (33 TL, 16 AL).
BULGULAR: AL kýrýðý olan 8 hastaya KSPE, 8 hastaya USPE uygulandý. Tüm TL hastalarý KSPE ile tedavi edildi. SCA tüm gruplarda anlamlý þekilde düzeldi (p<0.001). AL-USPE sonrasý fonksiyonel skorlar daha kötüydü: ortalama ODI 40.6±15.4 iken AL-KSPE’de 25.4±7.2 (p=0.040); VAS sýrasýyla 3.0±1.7 ve 2.2±2.4 (p=0.038). AL-KSPE sonrasý ODI ve VAS skorlarý TL-KSPE ile benzerdi (ODI p=0.255; VAS p=0.066). KSPE, %19 daha kýsa ameliyat süresi ve daha az kan kaybý ile eþdeðer radyolojik düzelme saðladý.
SONUÇ: Bu çalýþmada, SSPE yönteminin hem klinik hem de radyolojik açýdan AL kýrýklarýnýn tedavisi için güvenli bir seçenek olduðu bulunmuþtur. Buna karþýn, USPE yöntemi lomber fonksiyon üzerinde olumsuz etkileri olabileceðinden, yüksek derecede instabil yaralanmalarda uygulanmalýdýr.

Anahtar Kelimeler: Alt lomber kýrýklar, kýsa segment füzyon, uzun segment füzyon, posterior enstrümantasyon, Oswestry Engellilik Ýndeksi, sagittal Cobb açýsý.

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