[Unilateral versus bilateral pedicle fixation at the level of fracture in the treatment of thoracolumbar fractures with mild to moderate instability].

OBJECTIVE: To evaluate the efficacies of unilateral versus bilateral pedicle screw fixation through the pedicle of fractured vertebra plus short-segment pedicle instrumentation (SSPI) in the treatment of thoracolumbar fractures. METHODS: Between June 2008 and September 2010, a total of 46 patients with fractures of thoracolumbar junction, whose scores of load sharing classification (LSC) ranging from 5 to 7, underwent the combined treatment of SSPI and fracture level pedicle screw at our department. They were divided into 2 groups. Group I included 25 patients undergoing SSPI plus unilateral pedicle screw fixation through the pedicle of fractured vertebra (5 screws) while Group II included 21 patients had SSPI plus bilateral pedicle screw fixation through the pedicle of fractured vertebra (6 screws). The data of anterior body height compression (AVHC), sagittal Cobb's angle, internal fixation failure, restoration of nervous function, visual analogue score (VAS) and Oswestry disability index (ODI) were analyzed. RESULTS: The groups were similar with regards to age, gender, LSC, AVHC and sagittal Cobb's angle preoperatively. Blood loss volume and operative duration were less in the Group I (109.2 ± 30.68 vs 110.0 ± 32.06 min, t = -0.086, P > 0.05 and 376.0 ± 303.1 vs 409.5 ± 361.1 ml, t = -0.342, P > 0.05). They were followed up for a minimum period of 12 months. In follow-up period was 17.48 ± 4.14 months in Group I versus 18.33 ± 4.31 months in Group II (t = -0.683, P > 0.05). All patients with initial partial neurologic deficits improved at the final follow-up. Radiographic parameters and clinical outcomes were similar in both groups. CONCLUSIONS: Pedicle screw fixation through the pedicle of fractured vertebra plus SSPI is an excellent surgical therapeutic choice for patients with a LSC range of 5-7 thoraclumbar fractures. The efficacies of unilateral and bilateral pedicle screw fixation at fracture level are the same.