SURGICAL OUTCOME OF TRANSPEDICULAR FIXATION IN THORACOLUMBER FRACTURES
Abstract
Background: Development of transpedicular screw fixation techniques and instrumentation systemshas brought short-segment instrumentation (fixation of one normal vertebra above and below an
injured segment) into general clinical practice. The purpose of this study is to report the surgical
outcome of thoracolumber fractures treated with short-segment pedicle instrumentation. Methods: A
retrospective review of all surgically managed thoracolumbar fractures during two years was
performed. The 84 surgically managed patients were instrumented by the short-segment technique.
Patients charts, operation notes, preoperative and postoperative radiographs, computed tomographic
scans, magnetic resonance imaging (MRI) was done. Neurological findings (Frankel functional
classification), and follow-up records up to 6 months were reviewed. Results: Transpedicular
fixation was performed in 84 cases including 52 male and 32 female with male to female ratio 1.6:1.
Mean±SD of age was 40±13.75 years (range15-60). The level of injuries was different in different
age groups. Outcome was assessed on Frankle grading. No patient showed an increase in
neurological deficit. Most of the patients showed improvement to the next grade. Screw breakage
occurred in 8 cases, bed sores in 16 cases and deep vein thrombosis in 3 cases. Misplaced screw in
5 cases. Eight cases got wound infection. Conclusion: Although long term follow-up evaluation
needs to verified, the short term follow-up results suggest a favourable outcome for short-segment
instrumentation.
Keywords: Pedicle screw instrumentation, Thoracolumbar fracture, Short-segment, Fixation.
References
Jeffrey WP, Joel RL, Eldin EK, Robert WG. Successful
Short-Segment Instrumentation and Fusion for
Thoracolumbar Spine Fractures A Consecutive 4 1/2-Year
Series. Spine 2000;25:1157-69.
King D. Internal fixation for lumbosacral fusion. Am J Surg
;66:357-67.
Boucher HH. A method of spinal fusion. J Bone Joint Surg
;41:248.
Roy-Camille R, Saillant G, Mazel C: Internal fixation of the
lumbar spine with pedicle screw plating. Clin Orthop
;203:7-17.
Han IH, Song GS. Thoracic Pedicle Screw Fixation and
Fusion in Unstable Thoracic Spine Fractures. J Korean
Neurosurg Soc 2002;32:334-40.
Ahmet A, Emre A, Muharrem Y, Ali O, Adil S. ShortSegment Pedicle Instrumentation of Thoracolumbar Burst
J Ayub Med Coll Abbottabad 2008;20(4)
http://www.ayubmed.edu.pk/JAMC/PAST/20-4/Aziz.pdf 107
Fractures Does Transpedicular Intracorporeal Grafting
Prevent Early Failure? Spine 2001;26:213-7.
Been HD, Bouma GJ. Comparison of two Types of Surgery
for Thoraco-Lumbar Burst Fractures: Combined Anterior and
Posterior Stabilization vs. Posterior Instrumentation Only.
The Netherlands Acta Neurochir (Wien) 1999;141:349-57.
Kothe R, Panjabi MM, Liu W : Multidirectional instability of
the thoracic spine due to iatrogenic pedicle injuries during
transpedicular fixation. A biomechanical investigation. Spine
;22:1836-42.
Aebi M, Etter C, Kehl T. Stabilization of the lower thoracic
and lumbar spine the internal spine skeletal fixation system.
Indication, technique, and first results of treatment. Spine
;12:544-51.
Denis F, Armstrong GWD, Searis K. Acute thoracolumbar
burstfractures in the absence of neurologic deficits. Clin
Orthop Relat Res 1984;189:142-9.
Gertzbein SD, Court-Brown CM, Marks P. The neurologic
outcome following surgery for spinal fractures. Spine
;13:641-4.
Cantor JB, Labwohl NH, Garvey T: Nonoperative
management of stable thoracolumbar burst fractures with
early ambulation and bracing. Spine 1993;18:971-6.
Dickson JH, Harrington PR, Erwin WD. Results of reduction
and stabilization of the severely fractured thoracic and
lumbar spine. J Bone Joint Surg1978;60:799-805.
Jacobs RR, Casey MP. Surgical management of
thoracolumbar spinal injuries. Clin Orthop Relat Res
;189:22-35.
Bradford DS, Akbarnia BA, Winter RB: Surgical
stabilization of fractures and fracture dislocation of the
thoracic spine. Spine 1977;2:85-196.
McCormack T, Karaikovic E, Gaines RW. The load-shearing
classification of spine fractures. Spine 1994;19:1741-4.
Lee YS, Sung JK. Long-term Follow-up Results of Shortsegment Posterior Screw Fixation for Thoracolumbar Burst
Fractures. J Korean Neurosurg Soc 2005;37:416-21.
Blauth M, Tscherne M : Theraputic concept and results of
operative treatment in acute trauma of the thoracic and
lumbar spine : The Hanover experience. J Orthop Trauma
;1:240-52.
Farcy JP, Veidenbaum M, Glassman S. Sagittal index in
management of thoracolumbar burst fractures. Spine
;15:958-65.
Sasso RC, Costler HB : Posterior Instrumentation and fusion
for unstable fractures and fracture-dislocations of the thoracic
and lumbar spine. Spine 1993;18:450-60.
James JY, Allen S, Christopher S, Lawrence S, Kenneth W,
Mark T, et al. The Treatment of Unstable Thoracic Spine
Fractures with Transpedicular Screw Instrumentation: A 3-
Year Consecutive Series. Spine 2002;27:2782-7.
Kim KS, Oh SH, Huh JS, Noh JS, Chung BS. Dorsal ShortSegment Fixation for Unstable Thoracolumbar Junction
Fractures. J Korean Neurosurg Soc 2006;40:249-55.
Roy-Camille R, Saillant G, Salgado V. Osteogenesis of
thoracolumbar spine fractures with metal plates screwed
through the vertebral pedicle. Reconstr Surg Traumatol
;15:2-16.
Dorr LD, Harvey JP, Nickel VL. Clinical review of the early
stability of spine injuries. Spine 1982;7:545-53.
Frankel H, Hancock DO, Hyslop G. The value of postural
reduction in the initial management of closed injuries of the spine
with paraplegia and tetraplegia. Paraplegia 1969;7:179-92.
Patrick T, Russel CH, Christian AL, Dominique GP, Rene
PL. Functional and radiologic outcome of thoracolumbar and
burst fractures managed by closed orthopedic reduction and
casting. Spine 2003;28:2459-65.
Chun SW, Hwang JH, Sung JK, Hwang SK, Hamm IS, Park
YM, et al. Pedicle Screw Fixation and Posterolateral Fusion
for Thoracolumbar Spine Fracture. J Korean Neurosurg Soc
;28:644-8.
Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE.
Adjacent segment disease after lumbar ot lumbosacral fusion.
Spine 2004;29:1938-44.
Hyun SJ, Lim YB, Hong HJ, Kwon JT, Suk JS, Min BK.
Predictable risk factors for adjacent segment degeneration
after lumbar fusion. J Korean Neurosurg Soc 2007 41:88-94.
Aota Y, Kumano K, Hirabayashi S. Postfusion instability at
the adjacent segments after rigid pedicle screw fixation for
degenerative lumbar spinal disorders. J spine Disord
;8:464-73.
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