Fracture-Level Screws Augment Short-Segment Fixation in Thoracolumbar Burst Fractures

OBJECTIVE: To compare radiographic maintenance, disc degeneration, and functional outcomes between short-segment pedicle screw fixation (SPSF) alone and SPSF with fracture-level screws in thoracolumbar burst fractures (TLBFs). STUDY DESIGN: A retrospective comparative study. Place and Duration of the Study: Department of Orthopaedics, Daqing People's Hospital, Heilongjiang, China, from June 2015 to February 2025. METHODOLOGY: Adults with single-level T11-L2 TLBFs treated with posterior SPSF alone (control group) or SPSF with fracture-level fixation were reviewed. The Cobb angle and vertebral wedging index (VWI) were assessed at 1 week postoperatively and at final follow-up. Disc degeneration was graded on magnetic resonance imaging (MRI) after implant removal using the Pfirrmann classification. Pain and disability were evaluated using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). Normality was assessed with the Shapiro-Wilk test. Continuous outcomes were compared with the independent samples t-test or Mann-Whitney U test, as appropriate, and categorical variables were compared with the chi-square test or Fisher's exact test. A two-sided p-value of <0.05 was considered statistically significant. RESULTS: A total of 137 patients were included and divided into two groups: the control group (n = 68) and the fracture-level group (n = 69), with a follow-up period of 12-96 months. Operative time was longer in the fracture-level group (p <0.001), whereas blood loss was similar between the groups (p >0.05). At final follow-up, the Cobb angle and VWI were lower in the fracture-level group (both p <0.001). Severe disc degeneration (Pfirrmann grades 4-5) was less frequent in the fracture-level group (6/30 vs. 19/36, p = 0.013). CONCLUSION: The addition of fracture-level screws to SPSF improved long-term sagittal alignment and maintenance of vertebral height and was associated with less severe postoperative disc degeneration.