Is trans-fractured vertebra fixation necessary for TLBF? Spinal morphology and intervertebral disc degeneration differences: a retrospective study

The integrity of intervertebral discs is critical for the prognosis of thoracolumbar burst fractures (TLBF), yet research on postoperative disc degeneration remains scarce. This study compares the postoperative vertebral/spinal morphology, progression of disc degeneration, and functional recovery between short-segment pedicle screw fixation (SPSF) and SPSF combined with transfractured vertebra fixation, aiming to provide evidence for optimizing surgical strategies in TLBF. The baseline data, preoperative/postoperative imaging parameters, and functional scores of TLBF patients were retrospectively collected from electronic medical records, imaging systems, and follow-up evaluations. The comparative analyses were performed between SPSF (control group) and SPSF with trans-fractured vertebra fixation (experimental group) regarding vertebral translation (VT), Cobb angle, vertebral wedging index (VWI), spinal canal compromise (SCC), disc degeneration grading, perioperative parameters, and complications. Postoperative mid-to-short-term outcomes were comprehensively assessed. Fifty-two patients undergoing SPSF (control) and 55 patients receiving SPSF with trans-fractured vertebra fixation (experimental) were included. Both groups completed 4-week postoperative assessments and mid-to-short-term follow-ups (12–108 months). The baseline characteristics, preoperative parameters, and intraoperative blood loss showed no intergroup differences ( p > 0.05), while the experimental group exhibited longer surgical duration ( p = 0.001). At 4 weeks postoperatively, no intergroup differences were observed in vertebral/spinal morphological parameters ( p > 0.05). During final follow-up, VT and SCC remained stable compared to 4-week measurements in both groups, with no intergroup differences ( p > 0.05). However, Cobb angle and VWI maintenance diverged: the control group showed significant deterioration from 4-week values ( p < 0.05), whereas the experimental group maintained stability, demonstrating significant intergroup differences ( p < 0.001). In the subgroup analysis of patients undergoing implant removal ( n = 51), the experimental group exhibited lower progression of moderate-to-severe disc degeneration ( p = 0.03). No significant differences were observed in MCID achievement rates for VAS/ODI scores or complication rates between groups ( p > 0.05). SPSF with transfractured vertebra fixation confers a distinct clinical advantage: it significantly retards intervertebral disc degeneration at adjacent motion segments to the injured vertebra, while more effectively preserving VT and spinal alignment. Although these radiographic benefits did not translate into statistically significant intergroup differences in VAS or ODI scores during the mid-to-short-term follow-up, this technique remains a preferred surgical option for young and middle-aged patients with TLBF who prioritize long-term spinal health. Long-term functional benefits of this approach require validation through extended follow-up studies.