Abstract
OBJECTIVE: This study compared the outcomes of short-segment in situ fixation (SSF), long-segment fixation (LSF), and corpectomy for thoracolumbar burst fractures to identify the optimal fixation method. METHODS: We retrospectively analyzed 67 patients grouped into SSF (n=24), LSF (n=22), and corpectomy (n=21). Clinical and radiological parameters were assessed, including pre- and postoperative hemoglobin, numeric rating scale scores, American Spinal Injury Association scale grades, anterior vertebral body height (AVBH), spinal canal encroachment, Cobb angle, local kyphotic angle, operative time, and blood loss. RESULTS: Preoperatively, the corpectomy group demonstrated significantly lower AVBH (49.7%) and greater spinal canal encroachment (64.9%) compared with the SSF (62.6% and 39.9%) and LSF (58.4% and 43.0%) groups (p=0.006 and p<0.001, respectively). Postoperative outcomes were comparable among the three groups. Postoperative AVBH was 19.7 mm, 20.0 mm, and 20.5 mm in the SSF, LSF, and corpectomy groups, respectively (p=0.801). Likewise, postoperative local kyphotic angles were 9.4°, 10.8°, and 7.8°, respectively, showing no statistically significant differences (p=0.499). Effective spinal canal decompression was achieved in all groups. However, the corpectomy group required significantly longer operative times (mean, 343.1 minutes; p<0.001) and experienced greater intraoperative blood loss (mean, 1,634.2 cc; p=0.054). CONCLUSION: Severe preoperative AVBH loss (≤54.93%) and spinal canal encroachment (≥54.39%) may serve as practical thresholds for selecting corpectomy to achieve adequate decompression. In contrast, when these parameters are within acceptable ranges, SSF may be preferred in younger patients as it is less invasive, requires shorter operative time, and provides outcomes comparable to LSF.