Outcome of Thoracolumbar Burst Fractures Treated with Indirect Reduction and Fixation Without Fusion

Indirect reduction and fixation is not a new method in the treatment of thoracolumbar burst fractures but the indications and efficacy are controversial. The current study was designed to evaluate the efficacy of indirect reduction without fusion. Sixty-four patients with single-level thoracolumbar burst fractures were identified and treated by this method. The outcome was analyzed by the Frankel method, radiographic measurements, and at the latest follow-up the Denis Pain Scale and Oswestry disability index (ODI) were used to assess back pain and functional outcome. The average follow-up period was 40.1 months. The anterior vertebral height (AVH) was corrected from 55.2 to 97.2% post-operatively and decreased to 88.9% after hardware removal. The posterior vertebral height (PVH) increased from 88.9 to 99.1% post-operatively and decreased slightly after implant removal to 93.7%. The average pre-operative canal compromise was 41.4%, which decreased to 13.7% at last follow-up. Except for three paraplegic patients, neurological status significantly improved or stayed normal in the study's remaining 61 patients. Fifty-two of sixty-four patients had excellent or good function. At latest follow-up the average ODI score was 16.7 and the Denis pain score improved in all patients but one. Indirect reduction and fixation can not only restore vertebral column structure but also, more importantly, patients' functional outcome.