SHORT SEGMENT FIXATION WITH TRANSPEDICULAR SCREWS IN TRAUMATIC THORACOLUMBAR SPINE FRACTURES

Abstract

ABSTRACT

Aim:

The "gold standard" surgical treatment for an unstable thoracolumbar fracture is transpedicular screw fixation. Although traditional treatment supports long-segment posterior fixation (LSPF), more recent studies suggest short-segment posterior fixation (SSPF) with transpedicular screws, but incur higher failure rates. Thus, this study aimed to evaluate the effectiveness of SSPF in the management of traumatic unstable thoracolumbar injuries in terms of stability, deformation correction, neurological recovery, and pain relief.

Methods:

This prospective and observational hospital-based study was carried out in the Orthopedics Department of Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from August 2020 to July 2021. After Ethical clearance (UCMS/IRC/047/20) from the Institutional Review Committee (IRC) and informed written consent, all patients with a traumatic thoracolumbar fracture who fulfilled the inclusion criteria were enrolled in this study and were treated with SSPF. The fracture was classified according to Thoracolumbar injury classification and severity score (TLICS) and AO classification. Functional outcome was assessed according to neurological status, patient satisfaction, and pain assessment which was assessed by Frankel grading, Macnab grading, and Denis pain scale respectively. Post-operatively patients were regularly followed at 6 weeks, 3 months, and 6 months. The data was analyzed in SPSS 20 and descriptive statistics like frequency, percentage, mean and standard deviation were used to analyze the data. Chi-Square test, Independent sample t-test, and ANOVA tests were used as inferential statistics.

Results:

Thirty-one patients (16 females and 15 males) with traumatic thoracolumbar fracture were surgically managed with SSPF with a mean age of 38.61 ± 11.54 years. Twenty-seven patients (87.1 %) had fall injuries. The majority of cases (14 patients: 45.2%) had L1 vertebral fracture with a majority of the cases being wedge compression type (24 patients: 77.4%) and A1 type (24 patients: 77.4%). Posterior ligamental complex (PLC) was injured in 23 patients (74.2%) and 7 cases (22.6%) had neurological involvement. The majority of cases had a TLICS score of 4 (12 patients). The mean interval between trauma and surgery was 2.13 ± 0.71 days. The average duration of hospital stay was 13.10 ± 2.95 days and intraoperative average blood loss was 460±58.2 ml. In 16 cases, an additional screw was fixed through the intact pedicle of the fractured vertebra. Screw failure was the only complication seen in 2 cases (6.5%). Preoperatively, 20 cases (64.5%) had Frankel type E injury, mean Denis pain scale was 4.16±0.93, and mean preoperative kyphotic angle was 16.77±6.82 degree which improved to 26 cases (83.9%), 1.42±0.62, and 1.35±0.48 degrees at 6 months respectively. The mean loss of kyphotic correction angle was 0.58±0.88 (range 1-4) degrees. The majority of compression fracture cases had excellent to good patient satisfaction scores where 12(50%) and 10(41.7%) cases had excellent and good scores respectively (P 0.02). Concerning patient satisfaction score, a statistically significant difference was observed in mean TLICS score (P 0.101) and AO fracture type (P 0.034) while no difference was observed in PLC status (P 0.101) and additional screws (P 0.909). There was a statistically significant difference between the fracture type and improvement of Frankel grading at the end of six months follow up (P <0.001) where compression fracture managed with SSPF showed remarkable neurological recovery than burst fracture in terms of improvement of Frankel grading.

Conclusions:

Short segment transpedicular screw fixation is an effective treatment procedure for achieving better neurological recovery and good pain control in traumatic unstable thoracolumbar fractures.

Keywords:

Short segment, thoracolumbar spine fracture, transpedicular screw