Fig. 1

Photos of surgical procedures. After general anesthesia was induced, the patient was placed prone. A posterior midline approach was performed. One caudal adjacent and one cephalad adjacent spines to the fractured vertebra were exposed. The spinous processes and supraspinous ligaments were preserved. Pedicle screws with extension tabs were placed in adjacent spines above and below the fractured vertebra in preparation for ligamentotaxis using the posterior longitudinal ligament (PLL). Two straight rods were placed with set screws, one on each side. The vertebrae were distracted, and the set screws were tightened. The straight rods were subsequently replaced with lordotic-contoured rods one at a time to match physiologic lordosis. The thoracolumbar segment is the transitional area of the spine from thoracic kyphosis to lumbar lordosis. When dealing with L1 fracture, there is no need to contour the rod; the straight rod can solve the problem. In the CT-assisted group, an intraoperative CT scan was performed to assess the extent of spinal canal clearance by ligamentotaxis. A limited decompression of unilateral lamina was performed. The fractured vertebral body’s posterior wall was tamped ventrally (Intraoperative CT-scanning was performed to track and check whether the spinal canal’s posterior wall is reduced close to normal determine the residual bone mass position. It plays a decisive guiding role in the operation and avoids bilateral lamina fenestration under the premise of meticulous decompression). In the non-CT assisted group, bilateral limited lamina decompression was performed to obtain more thorough nerve decompression, which is beneficial to improve the surgical effect. The wound was irrigated, a drain was placed on each side, and the wound was closed in layers. The lateral portions of the facet joints directly adjacent to the transverse processes and the facet joints themselves of both groups’ fractured vertebrae were decorticated with a pneumatic burr until bleeding cancellous bone was visible. A composite artificial bone graft was placed along the decorticated lateral margin of the facet joints as well as within the facet joints