Short Segment Fixation with Inclusion of the Fractured Vertebra versus Long Segment Fixation for the Treatment of Thoracolumbar Fractures: A Randomized Controlled Trial

Abstract Thoracolumbar fractures often necessitate surgical stabilization to prevent instability and kyphotic deformity. Long-segment posterior fixation (LSF) provides robust mechanical support, but at the expense of increased surgical morbidity and reduced spinal mobility. Short-segment fixation with inclusion of the fractured level (SSFIFL) has emerged as a motion-preserving alternative with the potential for comparable outcomes. This study compares clinical and radiological outcomes between SSFIFL and LSF in patients with unstable thoracolumbar fractures. In this prospective randomized controlled trial, 54 patients with single-level unstable thoracolumbar fractures (T11–L2) were assigned to either LSF (n = 27) or SSFIFL (n = 27). Neurological function (ASIA grade, MRC scale) and radiological parameters (local kyphotic angle LKA, anterior and posterior vertebral body heights) were evaluated preoperatively, postoperatively, and at 3 and 6 months. Operative duration, intraoperative blood loss, hospital stay, and complications were also assessed. Both groups showed significant postoperative correction of LKA (p < 0.001), with no significant intergroup difference. LSF achieved superior vertebral height restoration (p < 0.001). Neurological improvement was observed in both groups, with comparable progression of ASIA grades. SSFIFL had advantages in operative time (p = 0.012), blood loss (p = 0.001), and hospital stay (p = 0.001). Complication rates were slightly lower in the SSFIFL group, with no implant failures observed. SSFIFL offers clinical and radiological outcomes comparable to LSF while reducing operative morbidity. It is a safe, effective, and motion-preserving alternative for select thoracolumbar fractures with intact pedicle support.