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Biomechanical comparison of three xation techniques for unstable

thoracolumbar burst fractures

Laboratory investigation
Frank L. Acosta Jr. 1 , 2 , Jenni M. Buckley 2 , Zheng Xu 2 , Jeffrey C. Lotz 2 and Christopher P.
Ames 1

DOI: https://doi.org/10.3171/SPI/2008/8/4/341

Object
Increased structural stability is considered suf cient justi cation for higher-risk surgical procedures,
such as circumferential xation after severe spinal destabilization. However, there is little biomechanical
evidence to support such claims, particularly after traumatic lumbar burst fracture. The authors sought
out to compare the biomechanical performance of the following 3 xation strategies for spinal
reconstruction after decompression for an unstable thoracolumbar burst fracture: 1) short-segment
anterolateral xation; 2) circumferential xation; and 3) extended anterolateral xation.

Methods
Thoracolumbar spines (T10–L4) from 7 donors (mean age at death 64 ± 6 years; 1 female and 6 males)
were tested in pure moment loading in exion–extension, lateral bending, and axial rotation.
Thoracolumbar burst fractures were surgically induced at L-1, and testing was repeated sequentially for
each of the following xation techniques: short-segment anterolateral, circumferential, and extended
anterolateral. Primary and coupled 3D motions were measured across the instrumented site (T12–L2) and
compared across treatment groups.

Results
Circumferential and extended anterolateral xations were statistically equivalent for primary and off-
axis range-of-motions in all loading directions, and short-segment anterolateral xation offered
signi cantly less rigidity than the other 2 methods.

Conclusions
The results of this study strongly suggest that extended anterolateral xation is biomechanically
comparable to circumferential fusion in the treatment of unstable thoracolumbar burst fractures with
posterior column and posterior ligamentous injury. In cases in which an anterior procedure may be
favored for load sharing or canal decompression, extension of the anterior instrumentation and fusion
one level above and below the unstable segment can result in near equivalent stability to a 2-stage
circumferential procedure.

Abbreviations used in this paper: ROM = range of motion; VB = vertebral body.

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