Comparison between short-segment versus long-segment screw fixation in osteopenic and osteoporotic vertebral compression fractures in thoracolumbar junction with myelopathy

Purpose Osteopenic and osteoporotic vertebral compression fracture (OVCF) is a prevalent clinical problem, particularly in the elderly. Management of this condition often requires surgical intervention involving screw fixation of vertebral bodies. However, the optimal extent of screw fixation remains a topic of debate among neurosurgeons. This retrospective study compared the clinical outcomes, radiographic results, and complication rates between short-segment and long-segment screw fixation in patients with OVCF at the thoracolumbar junction (TLJ) and with myelopathic symptoms due to a spinal cord-compressing lesion. Methods A total of 48 patients with OVCFs at the TLJ and myelopathic symptoms and who underwent either short-segment (two-level) or long-segment (>2 levels) screw fixation were studied. Clinical outcomes comprised Visual Analog Scale (VAS)score, Eastern Cooperative Oncology Group (ECOG) performance status, Frankel scale, and modified Japanese Orthopedic Association score. Results Both groups showed postoperative improvement in VAS scores, with no significant difference. However, postoperative improvement in Frankel scale (p=0.01) and ECOG performance status (p<0.01) was significantly greater in the short-segment versus long-segment fixation group. Conversely, long-segment fixation produced superior preservation of the postoperative correction angle (p=0.02). There were no significant differences in overall complication rates, including mechanical failure, between the two groups. Conclusion Short-segment screw fixation provides comparable clinical outcomes to long-segment fixation in the management of OVCFs with myelopathic symptoms. It is also noteworthy that short-segment screw fixation is not predisposed to instrument failure. These findings suggest that short-segment screw fixation may be a viable option for many patients with OVCFs, depending on clinical condition.