Posterior short-segment fixation with implanting pedicle screw in the fractured level as a feasible method for treatment of thoracolumbar fracture

Abstract

Background: The thoracolumbar spine is vulnerable to fracture in falls or motor vehicle accidents. Thoracolumbar spine fracture can be associated with neurological deficits, long-term pain and disability. The optimal management for these injuries remains a considerable subject for research. Objectives: To evaluate short-term surgical and functional outcome of posterior short-segment fixation with implanting pedicle screw in the fractured level (short same-segment fixation) for treatment of recent single-level traumatic thoracolumbar fracture. Methods: This prospective study included 36 patients with radiologically confirmed single-level thoracolumbar fracture. Patients were evaluated preoperatively, at time of discharge, and at follow-up visit after 1 year clinically using the Low-Back Outcome Scale of Greenough and Fraser Score, the American Spinal Injury Association (ASIA) for neurological evaluation, and the AO fracture classification for injury severity evaluation. Radiological evaluation included calculation of the sagittal index (SI) of injured vertebral body, anterior body compression (ABC) according to Mumford's equation, and regional kyphosis using Cobb angle. All patients underwent posterior trans-pedicular screw insertions into a vertebral body one level above and below the fracture site, and an additional pedicle screw was inserted at the level of the fracture. Postoperative clinical and radiological evaluations were compared to the preoperative. Results: All surgeries were conducted uneventfully within 129.7 ± 33.9 min with mean operative blood loss of 351.4 ± 140.5 ml. Wound infection was encountered in two patients and responded to conservative treatment. Mean duration of postoperative hospital stay and follow-up were 17.7 ± 4.4 days and 26.5 ± 5.1 months, respectively. After 1 year, mean low-back pain scores were significantly higher than preoperative and early postoperative scores and frequency of patients with excellent-good postoperative status was significantly higher at early postoperative evaluation and after 1 year compared to the preoperative status. Eight patients had neurological deficit, after 1-year follow-up; six patients were improved by one grade, while the other two cases remained stationary. Mean SI and ABC calculated at discharge and after 1 year were significantly higher compared to the preoperative measures. Mean Cobb angle was significantly decreased compared to the preoperative angle. Mean improvement of kyphosis angle at discharge and after 1 year was 60.9% and 48.1%, respectively; however, there was loss of kyphosis correction by about 4.2°after 1-year follow-up compared to the early postoperative finding.

Evaluation of outcome of posterior decompression and instrumented fusion in thoracolumbar fractures

“…5 Similar results have been reported by Adawi et al in their study of 36 patients. 18 The mean correction of kyphotic angle was from 33 degrees preoperatively to 12.8 degrees immediate post operatively and 17.1 degrees at 1 year follow-up. Two patients had implant failure in our study with a failure rate of 6.66%.…”

Clinico-Radiological Outcomes in Short Segment Fixation Including Fracture Level for Unstable Thoracolumbar Junction Fractures (T10-L2)

“…12,13 Regarding surgical interventions, our study recorded an average blood loss of 187 ± 34.35 ml, which was comparatively lower than the mean operative blood losses reported in other studies, ranging from 351.4 ml to 750 ml. 12,14,15 This could be due to number of reasons like operative techniques followed, medications used or methods of calculating blood loss and more.…”

Short-Segment Pedicle Fixation of Traumatic Low Lumbar Fractures (L3–L5)

“…7 Low lumbar fractures are relatively uncommon injuries that are anatomically and biomechanically different from fractures of the neighboring thoracolumbar region (T10-L2). Multiple studies have reported on the thoracolumbar [8][9][10][11][12][13] and lumbosacral region, 14 but few studies exist specifically regarding the lower lumbar region. Previous literature reports these fractures are predominant in combat-related spine injuries in US military conflicts.…”