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

Objectives: Osteopenic and osteoporotic vertebral compression fracture (OVCF) is a prevalent clinical problem, particularly in the elderly. Although the majority of compression fractures do not result in myelopathy and are managed nonoperatively, surgical intervention, including screw fixation, may be necessary in select cases of OVCF associated with myelopathy. 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 myelopathic symptoms due to a spinal cord-compressing lesion. Methods: A total of 48 patients with OVCFs at the TLJ and myelopathic symptoms, who underwent either short-segment (two-level, n=17) or long-segment (>2 levels, n=31) screw fixation were studied. Postoperative outcomes including clinical parameters, radiographic parameters, and incidence of complications were evaluated. Results: Postoperative improvement in Frankel scale was significantly greater in the short-segment versus long-segment fixation group (p=0.01). Long-segment fixation resulted in superior preservation of the postoperative correction angle (p<0.01). No difference in incidence of mechanical failure was demonstrated between the two groups (p=0.99). Conclusion: Short-segment fixation demonstrated greater postoperative neurological improvement and less invasiveness, whereas long-segment fixation was associated with superior preservation of the correction angle. It is also noteworthy that short-segment screw fixation is not predisposed to instrument failure compared to long-segment screw fixation. These findings suggest that short-segment screw fixation may be a viable option for many patients with OVCFs, depending on clinical condition.