The Effect of Fusion Levels on Clinical Outcomes in Lower Lumbar Vertebral Fractures

Purpose Fractures of the lower lumbar (LL) spine are relatively rare and the surgical management of fractures in this region remains uncertain. The aim of this study was to evaluate the mid- and long-term clinical and radiological outcomes of short segment posterior instrumentation (SSPI) and long segment posterior instrumentation (LSPI) for LL fractures. Methods Methods: A retrospective analysis was performed of patients who underwent posterior instrumentation for thoracolumbar (TL) and LL fractures between 2005 and 2022. Patients with at least 24 months of follow-up were included. The included patient cohort consisted of 49 patients, including 16 LL fractures (8 SSPI, 8 LSPI) and 33 TL fractures. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and visual analogue scale (VAS) for pain. Radiological outcomes were assessed by measuring the Sagittal Cobb Angle (SCA) preoperatively, postoperatively and at final follow-up. Statistical analyses were performed using non-parametric tests. Results The mean follow-up duration was 84 months. Functional assessments demonstrated significantly lower ODI and VAS scores in the LL SSPI and TL groups compared to the LL LSPI group (ODI: p = 0.019, VAS: p = 0.005). Among LL fractures, SSPI resulted in ODI (p = 0.255) and VAS (p = 0.066) scores comparable to TL fractures, suggesting minimal functional impairment. Radiologically, all groups exhibited significant improvements in SCA (p < 0.001). Conclusion Conclusion: According to the study, SSPI is an effective surgical approach for LL fractures and provides functional results comparable to surgery in the TL region.