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Research ArticleComplications

Unstable Thoracolumbar Injuries: Factors Affecting the Decision for Short-Segment vs Long-Segment Posterior Fixation

Juan P. Cabrera, Alfredo Guiroy, Charles A. Carazzo, Ratko Yurac, Marcelo Valacco, Emiliano Vialle, Andrei F. Joaquim and On behalf of the AO Spine Latin America Trauma Study Group
International Journal of Spine Surgery October 2022, 16 (5) 772-778; DOI: https://doi.org/10.14444/8337
Juan P. Cabrera
1 Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
2 Faculty of Medicine, University of Concepción, Concepción, Chile
MD
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Alfredo Guiroy
3 Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
MD
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Charles A. Carazzo
4 Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital – Passo Fundo – RS, Brazil
MD, MSᴄ
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Ratko Yurac
5 Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile
6 Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
MD
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Marcelo Valacco
7 Department of Orthopedic and Traumatology, Hospital Churruca Visca, Buenos Aires, Argentina
MD
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Emiliano Vialle
8 Orthopedic Department, Hospital Universitário Cajuru, Curitiba, Brazil
MD
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Andrei F. Joaquim
9 Department of Neurosurgery, University of Campinas (UNICAMP), Campinas-SP, Brazil
MD, PhD
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    Figure

    Distribution of patients receiving short-segment fixation (SSF) or long-segment fixation (LSF) according to the level of injury.

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    Table 1

    Clinical characteristics of patients with SSF vs LSF (N = 439).

    Variable n (%)SSF
    (n = 133)
    LSF
    (n = 306)
    P Value
    Age ≤39 y233 (53.1%)78 (58.6%)155 (50.7%)0.075
    Men324 (73.8%)93 (69.9%)231 (75.5%)0.223
    Public hospital358 (81.5%)101 (75.9%)257 (83.9%)0.046
    Hypertension33 (7.5%)4 (3.0%)29 (9.5%)0.018
    Diabetes mellitus19 (4.3%)5 (3.8%)14 (4.6%)0.699
    Obesity12 (2.7%)5 (3.8%)7 (2.3%)0.282a
    Smoker35 (8.0%)10 (7.5%)25 (8.2%)0.817
    Preoperative medical instability105 (23.9%)16 (12.0%)89 (29.1%)<0.001
    Implant’s availability82 (18.7%)29 (21.8%)53 (17.3%)0.268
    AO Spine injury
     B2245 (55.8%)107 (80.5%)138 (45.1%)<0.001
     B314 (3.2%)7 (5.3%)7 (2.3%)0.094a
     C180 (41.0%)19 (14.3%)161 (52.6%)<0.001
    Level of injury
     Upper thoracic65 (14.8%)5 (3.8%)60 (19.6%)<0.001
     Midthoracic78 (17.8%)9 (6.8%)69 (22.5%)<0.001
     Thoracolumbar265 (60.4%)106 (79.7%)159 (51.9%)<0.001
     Lumbar31 (7.1%)13 (9.8%)18 (5.9%)0.144
    Neurological status
     AIS A125 (28.5%)9 (6.8%)116 (37.9%)<0.001
     AIS B23 (5.2%)4 (3.0%)19 (6.2%)0.167
     AIS C30 (6.8%)8 (6.0%)22 (7.2%)0.654
     AIS D34 (7.7%)14 (10.5%)20 (6.5%)0.151
     AIS E227 (51.7%)98 (73.7%)129 (42.2%)<0.001
    • Abbreviations: AIS, ASIA Impairment Scale; ASIA, American Spinal Injury Association; LSF, long-segment fixation; SSF, short-segment fixation.

    • ↵a Fisher’s exact test.

    • View popup
    Table 2

    Univariate and multivariate logistic regression analysis for SSF.

    VariableUnivariateMultivariate
    OR (95% CI) P ValueOR (95% CI) P Value
    Age ≤39 y0.72 (0.48–1.09)0.0751.72 (1.03–2.87)0.038
    Men0.76 (0.48–1.19)0.223
    Public hospital0.60 (0.36–0.99)0.046
    Hypertension0.29 (0.10–0.86)0.0180.25 (0.08–0.81)0.021
    Diabetes mellitus0.82 (0.29–2.31)0.699
    Obesity1.67 (0.52–5.36)0.282
    Smoker0.91 (0.43–1.96)0.817
    Preoperative medical instability0.33 (0.19–0.59)<0.001
    Implant availability1.33 (0.80–2.21)0.268
    AO Spine injury
     B25.01 (3.09–8.13)<0.0013.54 (1.80–6.96)<0.001
     B32.37 (0.82–6.91)0.0949.41 (2.23–39.61)0.002
     C0.15 (0.09–0.26)<0.001
    Level of injury
     Upper thoracic0.16 (0.06–0.41)<0.0010.11 (0.03–0.38)0.001
     Midthoracic0.25 (0.12–0.52)<0.0010.17 (0.05–0.52)0.002
     Thoracolumbar3.63 (2.25–5.86)<0.001
     Lumbar1.73 (0.82–3.65)0.144
    Neurological status
     AIS A0.12 (0.06–0.24)<0.0010.32 (0.13–0.78)0.012
     AIS B0.47 (0.17–1.40)0.167
     AIS C0.83 (0.36–1.91)0.654
     AIS D1.68 (0.82–3.44)0.151
     AIS E3.84 (2.45–6.01)<0.001
    • Abbreviations: AIS, ASIA Impairment Scale; ASIA, American Spinal Injury Association; SSF, short-segment fixation;

    • a Fisher’s exact test.

    • View popup
    Table 3

    Complications reported according to SSF or LSF.

    VariableTotal (N = 439)SSF (n = 133)LSF (n = 306) P Value
    Any complication192 (43.7%)36 (27.1%)156 (50.9%)<0.001
    Pneumonia64 (14.6%)8 (6.0%)56 (18.3%)0.001
    Urinary tract infection59 (13.4%)9 (6.8%)50 (16.3%)0.007
    Deep vein thrombosis8 (1.8%)0 (0%)8 (2.6%)0.054a
    Pulmonary thromboembolism3 (0.7%)0 (0%)3 (1.0%)0.338a
    Postoperative hematoma4 (0.9%)0 (0%)4 (1.3%)0.235a
    Cerebrospinal fluid leak7 (1.6%)1 (0.8%)6 (2.0%)0.321
    Wound infection35 (8.0%)8 (6.0%)27 (8.8%)0.318
    Wound dehiscence17 (3.9%)2 (1.5%)15 (4.9%)0.09
    Neurological impairment1 (0.2%)0 (0%)1 (0.3%)0.697a
    Reintervention24 (5.5%)5 (3.8%)19 (6.2%)0.299
    Mortality3 (0.7%)0 (0%)3 (1.0%)0.338a
    • Abbreviations: LSF, long-segment fixation; SSF, short-segment fixation.

    • ↵a Fisher’s exact test.

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Unstable Thoracolumbar Injuries: Factors Affecting the Decision for Short-Segment vs Long-Segment Posterior Fixation
Juan P. Cabrera, Alfredo Guiroy, Charles A. Carazzo, Ratko Yurac, Marcelo Valacco, Emiliano Vialle, Andrei F. Joaquim, On behalf of the AO Spine Latin America Trauma Study Group
International Journal of Spine Surgery Oct 2022, 16 (5) 772-778; DOI: 10.14444/8337

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Unstable Thoracolumbar Injuries: Factors Affecting the Decision for Short-Segment vs Long-Segment Posterior Fixation
Juan P. Cabrera, Alfredo Guiroy, Charles A. Carazzo, Ratko Yurac, Marcelo Valacco, Emiliano Vialle, Andrei F. Joaquim, On behalf of the AO Spine Latin America Trauma Study Group
International Journal of Spine Surgery Oct 2022, 16 (5) 772-778; DOI: 10.14444/8337
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