Double Index Screw Fixation Improves Radiological Outcomes in Thoracolumbar Burst Fractures: Study

Vinoth Thangamani et al conducted a study to assess the radiological, clinical, and neurological outcome of patients who had thoracolumbar burst fractures and had undergone short-segment posterior stabilization with single-index screw (SIS) or double-index screws (DIS) at the fractured vertebra. The article has been published in ‘Indian journal of orthopedics.’The authors included patients with AO type A and B with thoracolumbar injury classification and severity score (TLICS) ≥ 5, load-sharing classification (LSC) score ≥ 7, and a follow-up period of more than 2 years. Of 94 patients, 45 had DIS fixation, and 49 had SIS fixation. All patientspre-operative, immediate post-operative, and final follow-up visit X-rays were analyzed for Cobbs angle (CA), vertebral wedge angle (VWA), and vertebral body compression ratio (VBCR) in a neutral lateral view and transverse spinal area (TSA) in axial CT section. Clinical and neurological outcomes were assessed using the Visual Analog Scale (VAS) for back pain, the Oswestry Disability Index (ODI), and the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at their final follow-up visit.
The key findings of the study were:
• The mean age in the SIS group was 43.7 years (range 19–58 years) and the DIS group was 48.5 years (range 17–55 years).
• The mean follow-up period in both groups was 29.5 months (range 24–96 months).
• The fractures were operated within 72 h in most patients (84.4%) with the maximum interval between injury and surgery being 34 days.
• The radiological parameters between both groups showed significant differences in terms of CA, VWA, and VBCR at the latest follow-up (SIS: 12.5°, 15°, 80.1% vs DIS: 8.04°, 11.2°, 87.1%) (p < 0.05).
• VAS and ODI were better in the DIS group but were statistically insignificant (p > 0.05).
The authors concluded – “Fixation of unstable thoracolumbar fractures with short-segment posterior stabilization with double-index screws (DIS) in the fractured vertebra resulted in radiologically better maintenance of CA, VWA, and VBCR compared to single index screw (SIS). Though the VAS and ODI were better in the DIS group, it was found to be statistically insignificant. There was no difference in spinal canal remodeling and neurological recovery in both groups.”Further reading:
Single vs Double Index Screws in Thoracolumbar Burst Fractures:
A Retrospective Analysis
Vinoth Thangamani et al
Indian Journal of Orthopaedics (2025) 59:1265–1273
https://doi.org/10.1007/s43465-025-01433-2