Background: The objective was to evaluate and compare the efficacy of direct fragment impaction, indirect reduction through ligamentotaxis, and the combination of both techniques in burst fractures of the thoracolumbar (TL) spine. Methods: The fractures were categorized using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and assessed via standard computed tomography (CT) scans for spinal canal area (SCA) and mid-sagittal diameter (MSD). The Frankel classification was used to assess neurological deficits. Only single vertebrae AO types A3 and A4 thoracic or lumbar fractures were included. All patients received bisegmental posterior stabilization, one of the reduction techniques, and, if neurological deficits were present, a spinal decompression. Mean preoperative (µSCApre/µMSDpre), postoperative (µSCApost/µMSDpost) and difference (∆SCA/∆MSD) in radiographic values were obtained and analyzed using the Mumford formula. The significance of the reduction from preoperative stenosis was assessed using a t-test, while the effectiveness of the reduction techniques was compared using the Kruskal-Wallis test and Dunn's post hoc test. The manuscript was focused primarily on radiographic outcomes; therefore, aside from the neurostatus, no other clinical parameters were statistically analyzed. Results: Thirteen patients (38.2%) received stand-alone indirect reduction, 13 patients (38.2%) underwent direct reduction, and a combined reduction was used in eight patients (23.6%). All methods resulted in a statistically significant reduction in spinal canal stenosis (p < 0.05), with a minimal mean ∆SCA of 19%. Patients in the direct reduction group had significantly higher µSCApre values compared to those in the indirect reduction group (p = 0.02). Conclusions: All of the tested reduction techniques provided a significant reduction in spinal canal stenosis. Patients who underwent mere direct reduction had significantly higher preoperative spinal canal stenosis compared to the indirect reduction group.

Department of Mathematics Faculty of Science Jan Evangelista Purkyne University in Usti nad Labem 400 96 Usti nad Labem Czech Republic

Department of Orthopaedic Surgery Faculty of Medicine in Hradec Kralove Charles University 500 03 Hradec Kralove Czech Republic

Department of Orthopaedics Faculty of Health Studies Jan Evangelista Purkyne University in Usti nad Labem and Masaryk Hospital 401 13 Usti nad Labem Czech Republic

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University and University Hospital Motol 150 06 Prague Czech Republic

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