SURGICAL OUTCOME OF TRANSPEDICULAR FIXATION IN THORACOLUMBER FRACTURES

Authors

  • Abdul Aziz Khan
  • Khalid Khanzada
  • Shahid Ayub
  • Mumtaz Ali

Abstract

Background: Development of transpedicular screw fixation techniques and instrumentation systemshas brought short-segment instrumentation (fixation of one normal vertebra above and below aninjured segment) into general clinical practice. The purpose of this study is to report the surgicaloutcome of thoracolumber fractures treated with short-segment pedicle instrumentation. Methods: Aretrospective review of all surgically managed thoracolumbar fractures during two years wasperformed. The 84 surgically managed patients were instrumented by the short-segment technique.Patients charts, operation notes, preoperative and postoperative radiographs, computed tomographicscans, magnetic resonance imaging (MRI) was done. Neurological findings (Frankel functionalclassification), and follow-up records up to 6 months were reviewed. Results: Transpedicularfixation 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 differentage groups. Outcome was assessed on Frankle grading. No patient showed an increase inneurological deficit. Most of the patients showed improvement to the next grade. Screw breakageoccurred in 8 cases, bed sores in 16 cases and deep vein thrombosis in 3 cases. Misplaced screw in5 cases. Eight cases got wound infection. Conclusion: Although long term follow-up evaluationneeds to verified, the short term follow-up results suggest a favourable outcome for short-segmentinstrumentation.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.

Published

2008-12-01

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