Background: Ardent debate exists with regards to ideal surgical management of thoracolumbar burst fractures, particularly regarding surgical approach and optimal construct. Posterior pedicle screw fixation either long, short, or mono-segmental have evolved as an accepted choice, yet the superiority of one over another is obscure. Short segment fixation that incorporates fractured vertebra (intermediate screw) has gained popularity even in severely unstable fractures. Purpose: To assess surgical, clinical, and radiological outcome in patients treated with short segment posterior fixation including fractured vertebra for unstable thoracolumbar burst fractures Study

Design: Prospective observational study Methods: 20 patients with single level unstable thoracolumbar fractures underwent short segment posterior fixation including fractured vertebra in National Trauma Center, Kathmandu, Nepal and were followed up for one year from January to December 2021. Demographic, injury, and surgical details were recorded. All patients were analyzed with conventional X-ray to evaluate Cobb angle, anterior vertebral body height (AVBH), retropulsion, and spinal canal width and clinically with Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and ASIA neurological grading. Radiological and clinical outcomes were assessed pre- and post-operatively at immediate postoperative, 2 weeks, 1 month, 3 month, 6 months, and 1 year.

Results: Age of the patients ranged from 18-63 years (mean: 33.6±8.75 years). 65% were males. L1 was the most common fractured vertebra. Predominant injury mechanism was fall from height. Complete neurologic injury was present in 5 patients and remaining had incomplete neurology. Mean pre-operative Cobb angle (26.7±3.7 0) augmented significantly to 8.55±2.150 at final follow up. Mean AVBH, retropulsion, and spinal canal width showed significant improvements post-operatively and were maintained till final follow up. Mean VAS and ODI score at one year were 2.25±0.83 and 25.1±5.87 %, respectively. There was no improvement in ASIA ‘A’ neurology patients while improvement in patients with incomplete neurology. No patient needed revision for loss of correction or failure of instrumentation.