Surgical outcome of posterior short segment trans-pedicle screw fixation for thoracolumbar fractures

Background: Vast majority of spine fractures in thoracolumbar region are unstable and often associated with neurological deficit. With the advancement of technology, these fractures are now more often managed operatively. The present study aimed at evaluating the role of open reduction & internal fixation using pedicle screws and short segment fixation in patients with Thoracic and Lumbar spine fractures. Design: In this prospective study, 25 patients in age group of 15-65 years (mean age 28.25 years) with thoracolumbar fractures with associated neurological deficit or compression fractures with loss of more than 50% vertebral height or angulations more than 20 degrees with or without neurological deficit were included. The results were evaluated based on restoration and maintenance of vertebral body height, spinal lordosis/kyphosis and evaluation of the neurological recovery which was done at regular intervals using Frankel's grading. Results: The mean follow-up period was 20.3 months. The average preoperative kyphotic angle as measured by Cobbs method was 20 degrees which improved to 7.8 degrees following instrumentation. The average preoperative vertebral height was 58.65% which improved to 78.55% postoperatively. Preoperatively, only 20% of patients had useful paraplegia (Frankel grade D and E) while 80% had useless paraplegia (Frankel's grade C and below). Following surgery, 60% patients had useful paraplegia while 40% had useless paraplegia. Conclusion: Short segment trans-pedicle posterior fixation is helpful for not only stabilization of the fractures and restoration of anatomy, but also maintaining the same over a period with good functional outcome. Copyright (C) 2013, Professor P K Surendran Memorial Education Foundation. Publishing Services by Reed Elsevier India Pvt. Ltd. All rights reserved.