The goal in the treatment of traumatic thoracolumbar burst fractures is to stabilize the spine to prevent short and long-term deformity and neurologic deficit while improving the clinical outcome of the patient. A number of studies have shown the clinical results of both operative and nonoperative treatments for these spinal traumatic fractures, but there is a lack of consensus with regard to the ideal operative treatment for these injuries. This lack of consensus is due to various types of thoracolumbar fractures and limited long-term data on clinical outcome and complications in the various types of surgical treatments.

Some of the coauthors of the article by Chou and colleagues previously reported the short-term results (with an average follow-up period of forty-one months) of their prospective randomized study comparing fusion with non-fusion short-segment posterior fixation for burst fractures of the thoracolumbar or lumbar spine. The results of that study showed several advantages of the non-fusion technique, including the elimination of donor site complications, the reduction of blood loss and operative time, and the preservation of more motion segments. However, the non-fusion group had a greater loss of correction in the sagittal plane; although this was not significant, this finding required long-term outcome assessment.

The present study by Chou et al. was designed to extend the previous study to ten years (with an average follow-up period of 134 months). Functional and radiographic outcomes (vertebral body height, kyphotic angle, and regional segmental motion) were investigated in the same patient groups. The results of the present study did not show significant differences in both functional and radiographic outcomes between fusion and non-fusion groups. However, regional segmental motion was preserved better in the non-fusion group compared with the fusion group at the time of both the two-year follow-up and the latest follow-up. In their previous study, the authors had emphasized the disadvantage of harvesting local autograft from the spinous process, which could have caused damage to the posterior column and could have increased the instability of the spine; the authors had concluded from that study that non-fusion surgery was advantageous to the preservation of segmental motion segments and the elimination of donor site complications.

The authors are to be congratulated for completing this long-term study. Despite a period of more than ten years, approximately 80% of the patients (twenty-two of twenty-eight in the non-fusion group, twenty-four of thirty in the fusion group, and forty-six of fifty-eight total) underwent follow-up for the latest investigation. The present study successfully showed the advantages of non-fusion short-segment posterior fixation for the thoracolumbar and lumbar burst fractures to preserve motion segments and to avoid the possible complications associated with autograft harvesting.