Balancing Stability and Invasiveness: An Updated Meta-Analysis of Short-Segment Versus Long-Segment Pedicle Screw Fixation in Thoracolumbar Burst Fractures
TL;DR
LSF provides superior deformity correction and mechanical stability, whereas SSF offers advantages in reducing surgical invasiveness, whereas Surgical strategy should be individualized based on patient-specific factors and treatment priorities.
Abstract
Background: The optimal posterior fixation strategy for thoracolumbar burst fractures remains controversial, particularly regarding the balance between biomechanical stability and surgical invasiveness. This study aimed to compare the efficacy and safety of short-segment fixation (SSF) versus long-segment fixation (LSF). Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library was performed for comparative studies published between 2020 to 2026 evaluating SSF and LSF in thoracolumbar burst fractures. The primary outcomes were Cobb angle correction and loss of correction. The secondary outcomes included intraoperative blood loss and implant failure. Pooled analyses were conducted using a random-effects model, reporting mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI). Results: Eight comparative studies involving 540 patients were included. LSF demonstrated significantly superior radiological outcomes, with greater Cobb angle correction (MD -2.33°, 95% CI -2.92 to -1.74; p < 0.00001) and substantially lower loss of correction (MD 3.36°, 95% CI 2.99 to 3.72; p < 0.00001), indicating enhanced maintenance of sagittal alignment. In contrast, SSF was associated with significantly reduced intraoperative blood loss (MD -170.00 mL, 95% CI -185.00 to -155.00; p < 0.00001), reflecting its less invasive nature. However, this advantage was offset by a significantly higher risk of implant failure in the SSF group (RR 2.75, 95% CI 1.46–5.18; p = 0.002). Notably, heterogeneity across all outcomes was negligible (I² = 0%), demonstrating a highly consistent and robust treatment effect across included studies. Conclusions: LSF provides superior deformity correction and mechanical stability, whereas SSF offers advantages in reducing surgical invasiveness. Surgical strategy should be individualized based on patient-specific factors and treatment priorities. Further research is warranted to confirm these findings and evaluate long-term functional outcomes. Keywords: Thoracolumbar Burst Fracture; Short-Segment Fixation; Long-Segment Fixation; Pedicle Screw; Spinal Stability