Short Segment Versus Long Segment Transpedicular Screw Fixation in the Correction and Preservation of AO-Type B Thoracolumbar Fracture Alignment: a Comparative Study

Thoracolumbar fractures represent the most common spinal injuries, predominantlyoccurring at the T11‐L2 junction due to the biomechanical transition from the rigidthoracic to the mobile lumbar spine. This region accounts for approximately half of alltraumatic spinal fractures, owing to changes in spinal curvature, facet jointorientation, and load‐bearing mechanics (1).Surgical management aims to restore spinal stability, correct kyphotic deformity,decompress neural elements, and enable early mobilization. Two posterior fixationstrategies exist: short‐segment fixation (SSF), spanning one level above and below thefracture with one or 2 intermediate screws in the fractured vertebra itself, andlong‐segment fixation (LSF), spanning two or more levels above and below with one or 2intermediate screws in the fractured vertebra itself. Short‐segment constructs preservemore motion segments with reduced surgical morbidity, while long‐segment constructsprovide potentially greater stability (2).The optimal choice remains debated. A 2025 meta‐analysis of 17 trials (1,031 patients)showed that LSF was associated with higher blood loss and longer operative time butbetter kyphosis correction maintenance and pain improvement (3). Short‐segment fixationwith intermediate screws at the fracture level has shown comparable results to LSF whilepreserving motion segments and reducing costs (4).There is no randomized trial on AO‐type B. Given these controversies, a prospectivecomparative study in our population is warranted.