Percutaneous Treatment of Traumatic A3 Burst Fractures of the Thoracolumbar Junction Without Neurological Impairment: The Role of Timing and Characteristics of Fragment Blocks on Ligamentotaxis Efficiency

TL;DR

This study shows that early surgery improves spinal recovery in patients with certain thoracolumbar fractures.

Contribution

The study identifies the impact of surgical timing and fragment block characteristics on ligamentotaxis effectiveness in A3 burst fractures.

Findings

Early surgery (<72 h) significantly improves spinal canal area and local kyphotic angle.

Fragment height ratio correlates with spinal canal area improvement.

Percutaneous short-segment fixation is effective for thoracolumbar A3 fractures without neurological issues.

Abstract

Background: This study aims to evaluate how surgical timing and the radiological characteristics of fragment blocks can affect the effectiveness of ligamentotaxis, in restoring the spinal canal area, and local kyphosis in adults with traumatic thoracolumbar A3 burst fractures without neurological impairment treated with percutaneous short-segment fixation. Methods: A retrospective observational study was conducted between January 2016 and December 2022 on neurologically intact adult patients with a single A3 thoracolumbar fracture. Data collected included demographics, injury mechanism, fracture level, and clinical and surgical details. Radiological assessments included spinal canal area, local kyphotic angle, anterior and posterior vertebral heights, and fragment block measurements. Results: Out of 101 treated patients, 9 met the criteria with a mean age of 52.22 years. Most fractures were at L1 (88.89%). All patients had moderate-to-severe pain (NRS 6.22 ± 1.09) at baseline. Five patients (55.55%) underwent surgery within 72 h, with a mean surgical time of 109.22 min. SCA and LKA values improved significantly in all patients post-surgery. Early surgical intervention (<72 h) correlated with greater improvements in spinal canal area (p = 0.016) and local kyphotic angle (p = 0.004). A significant association was found between spinal canal area improvement and the percentage ratio of fragment height to “normal” vertebral height (rho = 0.682; p = 0.043). Conclusions: Early (<72 h) short-segment percutaneous fixation is recommended for adults with high functional demands and moderate-to-severe axial pain due to single traumatic A3N0M0 thoracolumbar fracture. This “upfront” approach is associated with enhanced indirect decompression and better local kyphotic angle restoration. Considering the fragment morphology could also be important in surgical planning.

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