RADIOLOGICAL OUTCOME OF TRANSPEDICULAR SCREWS FIXATION IN THE MANAGEMENT OF THORACOLUMBAR SPINE INJURY

Authors

  • Mian Iftikhar ul Haq
  • Shahbaz Ali Khan
  • Ahsan Aurangzeb
  • Ehtisham Ahmed
  • Sajid Nazir Bhatti
  • Ali Noman

Abstract

Background: Traumatic fracture of the spine is a serious neurosurgical condition that has serious impact on the patient’s quality of life. Thoracolumbar junction is the most common site of spinal injuries. The aims of management of thoracolumbar spinal fractures are to restore vertebral column stability, and to obtain spinal canal decompression. This ultimately leads to early mobilization of the patients. This study was conducted to compare preoperative and post-operative vertebral height, kyphotic angle and sagittal index in patients treated with pedicle screws and rods in thoracolumbar spine fractures. Methods: This cross-sectional study was conducted in the department of Neurosurgery, Hayatabad Medical Complex, Peshawar from 1st. February 2010 to 31st. July 2011. A total 161 patients with unstable thoracolumber spine fracture were included in this study. In these patients fixation was done through transpedicle screws with rods. Anteroposterior and lateral views X-rays of thoraco-lumbar spine were done pre and post operatively. Results: Out of 161 patients, 109 (67.7%) were males and 52 (32.3%) females. The age of patients ranged from 20 to 70 years (mean 42.2 years) with 71 (44.1%) in the age range of 31–40 years. Preoperative average vertebral height was 9.4194 mm while postoperative average was 19.642 mm. The mean kyphosis was 23.06° preoperatively. Immediately after surgery the average correction of kyphosis was 9.45°. The pre-operative average sagittal index was 19.38°, which was reduced to an average 5.41° post operatively. Conclusions: Transpedicular fixation for unstable thoraco-lumbar spinal fractures achieves a stable fracture segment with improvement of vertebral height, kyphotic angle and sagittal index. Hence, preventing the secondary spinal deformities.Keywords: Radiological outcome, Transpedicular screws fixation, thoracolumbar spine injury

References

Ahmed NM, Ibrahim HB, Farg A, Sleem A. Avoidable causes in pedicle instrumentation failure. Pan Arab J Neurosurg 2011;15(1):29–34.

Modi HN, Chung KJ, Seo W, Yoon HS, Hwang JH, Kim HK, et al. Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with parial or intact neurology. J Orthop Surg Res 2009;4:28.

Milenkovic S, Saveski J, Trajkovska N, Vidic G, Radekovic M. Transpedicular Screw Fixation of Thoracolumbar Spine Fractures. Acta Facultatis Medicae Naissensis 2010;27(2):63–8.

Yue JJ, Sossan A, Selgrath C, Deutsch LS, Wilkens K, Testaluti M, et al. The Treatment of unstable thoracic spine fractures with transpedicular screw instruementation: a 3-year consecutive series. Spine 2002;27(24):2782–7.

Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh S, Fujiya M. Anterior decompression and stabilization with the kaneda devise for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg Am 1997;79:69–83.

Carl AL, Tromanhauser SG, Roger DL. Pedicle screw instrumentation for thoracolumbar burst fractures and fracture dislocation. Spine 1992;17:S317–24.

Riaz-ur-Rehman, Azmatullah, Azam F, Mushtaq, Shah M. Treatment of traumatic unstable thoracolumbar junction fractures with transpedicular screw fixation. J Pak Med Assoc 2011;61(10):1005–8.

Kim MS, Eun JP, Park JS. Radiological and clinical results of laminectomy and posterior stabilization for severe thoracolumbar burst fracture: surgical technique for one stage operation. J Koreon Neurosurg Soc 2011;50(3):224–30.

King D. Internal fixation for lumbosacral fusion. Am J Surg 1944; 66:357–67.

Boucher HH. A method of spinal fusion. J Bone Joint Surg 1959;41:248.

Gerzbein SD, Scoliosis Research Society: multicenter spine fracture study. Spine 1992;17:528–39.

Price C, Makintubee S, Herndon W, Istre GR. Epidemiology of traumatic spinal cord injury and acute hospitalization and rehabilitation: Charges for spinal cord injuries In Oklahoma,1988-1990. Am J Epidemiol 1994;139(1):37–47.

Whang PG, Vaccaro AR. Spine Pedicle Fixation Revisited: the role of X-Rays and other surgical factors. Spine 2006;31:717–21.

Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res 1986;203:7–17.

Gaines RW. Current Concepts Review, the use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg 2000;72A(10):1458–76.

Marco RA, Kushwaha VP. Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction. J Bone Joint Surg Am 2009;91(1):20–8.

Whang GL, Yang HL, Cai X, Shi JH, Tang TH. Diagnosis and surgical treatment of thoracolumbar vertebral chances fractures caused by a fall. Zhonghua Wai Ke Za Zhi 2008;46(10):741–4.

Tabak AY, Gunay MC, Altay M, Turker HB. Effects of short and long-segment posterior instrumentation on spinal canal remodeling in thoracolumbar vertebra burst fractures. Ulus Trauma Acil Cerrahi Derg 2011;17(2):141–8.

Mohanty SP, Bhat SN, Ishwara-Keerthi C. The effect of posterior instrumentation of the spine on canal dimensions and neurological recovery in thoracolumbar and lumbar burst fractures. Musculoskelet Surg 2011;95(2):101–6.

Yousafzadeh Chabok S, Safaee M, Alizadeh A, Ahmadi DM, Taghinnejadi O, Koochakinejad L. Epidemiology of traumatic spinal injury: a descriptive study. Acta Med Iran 2010;48(5):308–11.

Hasler RM, Exadaktylos AK, Bouamra O, Benneker LM, Clancy M, Sieber R, Zimmermann H, Lecky F. Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study. Eur Spine J 2011;20(12):2174–80.

Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994;3:184–201.

Helton LA, Defino Fabiano RTC. Low thoracic and lumbar burst fractures: radiographic and functional outcomes. Eu Spine J 2007;16:1934–43.

Arif M, Inam M, Shabir M. Management of Thoracolumbar Spinal Fracture by Pedicular Screws and Rods. J Posgad Med Institute 2009;7(2):109–13.

Afzal S, Mir MR, Halwai MA, Shabir A. Steffee (VSP) instrumentation for the surgical management of thoracolumbar spinal fractures.(a study of 20 cases). JK-Practitioner 2002;94:227–30.

Downloads

Published

2015-03-01

Most read articles by the same author(s)

1 2 3 4 5 > >>