***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Abstract . Short-segment posterior instrumentation for the treatment of thoracolumbar burst fractures has been reported with a high rate of failure .  Transpedicular intracorporeal grafting in combination with short-segment instrumentation has been offered as an alternative to prevent failure . However , concern still remains about the potential complication of further canal narrowing or failure of remodeling with this technique . The purpose of this prospect i ve , r and omized , controlled study is to evaluate the effect of transpedicular intracorporeal grafting on spinal canal restoration and remodeling in a group of patients treated with short-segment instrumentation for thoracolumbar burst fractures . Twenty-one patients with thoracolumbar burst fractures were r and omised into  transpedicular grafting ( TPG ) ( n=11 ) and non- transpedicular grafting ( NTPG ) ( n=10 ) groups , and were prospect ively followed for an average of 50 months ( range 25–85 months ) . Groups were similar in age , type of fracture , load sharing classification and kyphotic deformity . Preoperative , postoperative and follow-up computed tomographic ( CT ) images through the level of pedicles were obtained , corrected for differences in magnification , and digitized . Areas of the spinal canals were measured and normalized by the estimated area at that level ( average of adjacent levels ) . Average kyphosis was 19.7 ° ±6.2 ° at presentation , was corrected to 1.9 ° ±4.9 ° by operation , but was found to have deteriorated to 9.1 ° ±6.4 ° at final follow-up . There were no differences between groups regarding the evolution of sagittal deformity . Spinal canal narrowing was 38.5±18.2 % at presentation , 22.1±19.8 % postoperatively , and it further improved to –2.5±16.7 % at follow-up , similar for both groups . Our results demonstrate that transpedicular intracorporeal grafting in the treatment of burst fractures does not have a detectable effect on the rate of reconstruction of the canal area or on remodeling . Spinal canal remodeling was observed to occur in all patients regardless of grafting Short segment posterior fixation is the preferred method for stabilizing thoracolumbar fractures . In case of significant disruption of the anterior column , the simple short segment construct does not ensure adequate stability . In this study , we tried to evaluate the effect of inclusion of the fractured vertebra in short segment fixation of thoracolumbar fractures . In a prospect i ve r and omized study , eighty patients with thoracolumbar fractures treated just with posterior pedicular fixation  were r and omized into two groups receiving either the one level above and one level below excluding the fracture level ( bridging group ) , or including the fracture level ( including group ) . Different clinical and radiological parameters were recorded and followed . A sum of 80 patients ( 42 patients in group 1 and 38 patients in group 2 ) were enrolled in the study . The patients in both the groups showed similar clinical outcome . There was a high rate of instrumentation failure in the “ bridging ” group . The “ bridging ” group showed a mean worsening ( 29 % ) in kyphosis , whereas the “ including ” group improved significantly by a mean of 6 % . The significant effect of the “ including ” technique on the reduction of kyphotic deformity was most prominent in type C fractures . In conclusion , inclusion of the fracture level into the construct offers a better kyphosis correction , in addition to fewer instrument failures , without additional complications , and with a comparable-if not better- clinical and functional outcome . We recommend insertion of screws into pedicles of the fractured thoracolumbar vertebra when considering a short segment posterior fixation , especially in Magerl type C fractures OBJECTIVE The treatment of thoracolumbar burst fracture is a controversial issue . Although spinal fusion has been a touchstone of spinal fixation , nonfusion technique have become raising its popularity recently . Some studies suggested that nonfusion had several advantages over fusion . The aim of this prospect i ve study was to compare long segment posterior instrumentation with fusion versus long-segment posterior instrumentation without fusion . METHODS For this purpose , 42 consecutive patients were assigned to two groups . Group 1 included 21 patients treated by long segment instrumentation with fusion ( WF ) , whereas Group 2 included 21 patients treated by long segment instrumentation without fusion ( WOF ) .  Long segment instrumentation was hook fixation ( claw hooks attached to second upper vertebra and infralaminar hooks attached to first upper vertebra ) above and pedicle fixation ( pedicle screws attached to first and second lower vertebrae ) below the fractured vertebra . RESULTS Measurements of local kyphosis , sagittal index and anterior vertebral height compression showed that both group had similar outcome at final follow-up . Moreover , there was no difference between the two groups according to low back outcome score . Also , implant failure rate ( 4.7 % ) was quite low in both groups . However , WF group had prolonged operative time , increased blood loss and donor site morbidity . CONCLUSIONS Radiological and clinical parameters demonstrated that spinal fusion is not necessary in long segment posterior instrumentation for the management of thoracolumbar burst fractures Study Design . A prospect i ve , r and omized study comparing two treatment methods for thoracolumbar burst fractures :  short-segment instrumentation with transpedicular grafting and the same procedure without transpedicular grafting . Objective . To evaluate the efficacy of transpedicular grafting in preventing failure of short-segment fixation for the treatment of thoracolumbar burst fractures . Summary of Background Data . Short-segment pedicle instrumentation for thoracolumbar burst fractures is known to fail early because of the absence of anterior support . Additional transpedicular grafting has been offered as an alternative to prevent this failure . However , there is controversy about the results of transpedicular grafting . Methods . Twenty patients with thoracolumbar burst fractures were included in the study . The inclusion criterion was the presence of fractures through the T11–L3 vertebrae without neurologic compromise . The patients were r and omized by a simple method into two groups . Group 1 patients were treated using short-segment instrumentation with transpedicular grafting ( TPG ) ( n = 10 ) , and Group 2 patients were treated by short-segment fixation alone ( NTPG ) ( n = 10 ) . Clinical ( Likert ’s question naire ) and radiologic ( sagittal index , percentage of anterior body height compression , and local kyphosis ) outcomes were analyzed . Results . The two groups were similar in age , follow-up period , and severity of the deformity and fracture . The postoperative and follow-up sagittal index , percentage of anterior body height compression , and average correction loss in local kyphosis in both groups were not significantly different . The failure rate , defined as an increase of 10 ° or more in local kyphosis and /or screw breakage , was also not significantly different ( TPG = 50 % , NTPG = 40 % , P = 0.99 ) . Conclusions . Short-segment transpedicular instrumentation of thoracolumbar burst fractures is associated with a high rate of failure that can not be decreased by additional transpedicular intracorporeal grafting Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT Statement , added 1 item , and developed a modified flow diagram . To allow adequate underst and ing and implementation of the CONSORT extension , the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting . This extension , in conjunction with the main CONSORT Statement and other CONSORT extensions , should help to improve the reporting of RCTs performed in this field BACKGROUND The impact of fusion as a supplement to short-segment instrumentation for the treatment of thoracolumbar burst fractures is unclear . We conducted a controlled clinical trial to define the effect of fusion on lumbar spine and patient-related functional outcomes . METHODS From 2000 to 2002 , seventy-three consecutive patients with a single-level Denis type-B burst fracture involving the thoracolumbar spine and a load-sharing score of < or=6 were managed with posterior pedicle screw instrumentation .  The patients were r and omly assigned to treatment with posterolateral fusion ( fusion group , n = 37 ) or without posterolateral fusion ( nonfusion group , n = 36 ) . The patients were followed for at least five years after surgery and were assessed with regard to clinical and radiographic outcomes . Clinical outcomes were evaluated with use of the Frankel scale , the motor score of the American Spinal Injury Association , a visual analog scale , and the Short Form-36 ( SF-36 ) question naire . Radiographic outcomes were assessed on the basis of the local kyphosis angle and loss of kyphosis correction . RESULTS No significant difference in radiographic or clinical outcomes was noted between the patients managed with the two techniques . Both operative time and blood loss were significantly less in the nonfusion group compared with the fusion group ( p < 0.05 ) . Twenty-five of the thirty-seven patients in the fusion group still had some degree of donor-site pain at the time of the latest examination . CONCLUSIONS Posterolateral bone-grafting is not necessary when a Denis type-B thoracolumbar burst fracture associated with a load-sharing score of < or=6 is treated with short-segment pedicle screw fixation Objective . To evaluate the effectiveness of 2 different types of Cotrel-Dubousset instrument systems in stabilising thoracolumbar and lumbar spine fractures . Methods . Between January 1989 and December 1993 , 45 fractures in 42 patients with unstable fracture or fracture dislocation of the thoracolumbar and lumbar spines were r and omly assigned to 2 surgical treatments with Cotrel-Dubousset instrumentation — using either a long segment ( Group 1 ) or a short segment ( Group 2)— and short posterolateral fusion . Results . Consolidation of the fractured vertebral body and posterolateral fusion were achieved at a mean time of 4.5 months ; fusion rates were 75 % in Group 1 and 83 % in Group 2 . The average collapses of anterior vertebral body height in Group 1 , in the immediate postoperative period and at the final follow-up , were 15 % and 17 % , respectively ; and in Group 2 , the figures were 16 % and 24 % , respectively . The correction of vertebral height and kyphosis at the last follow-up were lost more in Group 2 ( 5.7 ° ) than in Group 1 ( 4.4 ° ) . There were neurological recoveries in 6 of the 9 cases of incomplete paraplegics , including complete recovery in 5 , and one-Frankel grade increase in one . There were 15 instrument failures in 12 patients , including screw breakage in 3 Group 1 cases and 6 Group 2 cases . The plug dislodged in 3 Group 1 cases , and the hook dislodged in 3 Group 2 cases . In other words , instrument failures were more common in Group 2 . Conclusion . Cotrel-Dubousset stabilisation of the fractured spine achieves fracture consolidation , but does not maintain the restored height and sagittal curve completely until fusion . The long rod and short fusion construct was more effective for all fracture types than was the short rod and fusion construct , although it leads to wider immobilisation of normal segments BACKGROUND To our knowledge , a prospect i ve , r and omized study comparing operative and nonoperative treatment of a thoracolumbar burst fracture in patients without a neurological deficit has never been performed . Our hypothesis was that operative treatment would lead to superior long-term clinical outcomes . METHODS From 1994 to 1998 , forty-seven consecutive patients ( thirty-two men and fifteen women ) with a stable thoracolumbar burst fracture and no neurological deficit were r and omized to one of two treatment groups : operative ( posterior or anterior arthrodesis and instrumentation ) or nonoperative treatment ( application of a body cast or orthosis ) . Radiographs and computed tomography scans were analyzed for sagittal alignment and canal compromise . All patients completed a question naire to assess any disability they may have had before the injury , and they indicated the degree of pain at the time of presentation with use of a visual analog scale . The average duration of follow-up was forty-four months ( minimum , twenty-four months ) . After treatment , patients indicated the degree of pain with use of the visual analog scale and they completed the Rol and and Morris disability question naire , the Oswestry back-pain question naire , and the Short Form-36 ( SF-36 ) health survey . RESULTS In the operative group ( twenty-four patients ) , the average fracture kyphosis was 10.1 degrees at the time of admission and 13 degrees at the final follow-up evaluation . The average canal compromise was 39 % on admission , and it improved to 22 % at the final follow-up examination . In the nonoperative group ( twenty- 
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Research ers found no differences between the two groups in function and quality of life or pain .
Overall , evidence is insufficient to inform the selection of different methods of pedicle screw fixation or the combined use of fusion .