Single-Stage Versus Two-Stage 360° Stabilization Procedure in Unstable Thoracolumbar Burst Fractures – A Retrospective Quasi-Experimental Analysis

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Study Design Retrospective quasi-experimental study conducted at two Level I trauma centers over a 6-year-period. Objectives Unstable thoracolumbar burst fractures are frequently treated by circumferential (360°) stabilization. Due to ongoing debate, this study aimed to compare whether single- or two-stage 360° stabilization leads to a shorter hospital length of stay in those patients. Methods Non-polytraumatized adults (ISS ≤15) with unstable thoracolumbar fractures who underwent 360° stabilization were included. Total hospital length of stay was defined as primary outcome. Secondary outcomes were operative time, intraoperative blood loss and in-hospital mortality. Mann-Whitney U and chi-square tests were applied to compare continuous and categorical variables, respectively, with P < 0.05 as the threshold for significance. Results A total of 184 patients was eligible (single-stage, n = 104; two-stage, n = 80). Age, sex distribution, and ASA scores did not differ between both groups. Hospital length of stay was significantly shorter in the single-stage group (9+/−4 days) compared to the two-stage group (11+/−5 days; P < 0.001). Operative time was significantly shorter in the single-stage group (194+/−75 min) compared to the two-stage group (230+/−91 min; P = 0.003). Blood loss was significantly less in the single-stage group (500+/−400 mL) compared to the two-stage group (750+/−635 mL; P = 0.033). There was no in-hospital mortality in both groups. Conclusions Single-stage 360° stabilization for unstable thoracolumbar fractures in non-polytraumatized patients is superior to the two-stage approach regarding length of hospital stay, operative time, and intraoperative blood loss. Consequently, a single-stage procedure should be preferred whenever feasible.

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