Short term functional and neurological outcome of short segment pedicle screw fixation in unstable thoracolumbar burst fractures
Journal Title: Medpulse International Journal of Orthopedics - Year 2019, Vol 10, Issue 2
Abstract
Background: Burst fractures are the most common type of thoracolumbar spine fractures (21-58%) associated with kyphotic deformity and neurological deficits. The treatment goals include restoration of spinal stability, kyphotic deformity correction and decompression of the spinal canal. Short segment pedicle screw fixation has become an increasingly popular, most common and simple method of treatment of thoracolumbar burst fractures, providing the advantage of incorporating fewer motion segments in the fixation and also prevents excessive loads on the adjacent discs. Methodology:It is a prospective study between January 2015 to January 2018, included a total of 60 patients who were operated with short segment pedicle screw fixation for unstable thoracolumbar burst fractures with TLICS score 4 or more than 4. Neurological evaluationwas done usingAmerican Spinal Injury Association (ASIA) grading and fracture classified using AO classification.Sagittal Angle (SA)and Sagittal Index (SI)were calculated in plain radiograph of the TL spinepre-operatively, post-operatively and at final follow-up.All patients were followed up post operatively at 1,3,6 and 12 months for neurological and radiological evaluation.Results:Our studythrew light on many aspects of thoracolumbar burst fractures. Fall from height was themost common mode of injury, followed by motor traffic accident.T12 vertebra was the most common level of incidence with 31.6%followed by L1 vertebra at 26.6%.34 patients had A3type of AO fracture and 26 patients A4 type.Out of the 60 cases,12 had complete neurological injury (ASIA A), 48 had incomplete injury (ASIA B,C,D).4cases(33%)among complete neurological injury had improvement by one grade and 2cases (16.6%) had improvement by two grade in ASIA charting.Among 48 incomplete injuries 27 (56.25%)showed two grade improvement and 20patients (41.6%) showed one grade improvement at final follow up. Sagittal Angle (mean) improved from 21.80 to 9.460 immediate post-op and a gradual decrease of 1.70 noted at final follow-up. Conclusion: Short segment pedicle screw fixation without fusion is a safe and effective method as it achieves good stabilization with comparableneurological recovery, when addressed at the earliest.Short segment pedicle screw fixation also provides chance for early mobilisation thereby reducing the complication associated with long term recumbent bed rest in patients with unstable thoracolumbar fractures. Comparable Sagittal angle and sagittal index can be achieved to near normal by this method,maintaining the spinal curvature thereby by-passing associated complications of long segment fixation.
Authors and Affiliations
Gurumurthy B, Madhukesh Rudramurthy, SujanaTheja J S, Manjunatha D N
Keywords
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- EP ID EP617238
- DOI 10.26611/10201027
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