Outcome of short segment pedicular instrumentation with intermediate screw and fusion in thoracolumbar fracture

Abstract

Study design: In this prospective randomized study, The results of Treating Unstable   thoracolumbar burst fracture by pedicle instrumentation with fracture level screw combination were given.

Objective: To evaluate the effectiveness of short-segment pedicle fixation with intermediate screws.

Methods: A prospective study was done of 30 patients with thoracolumbar Fractures who were treated with posterior short segment pedicular fixation with intermediate screw fixation. Anterior vertebral body height compression percentage (AVBCP), regional kyphosis angle and local kyphosis were measured and analysed preoperatively, post-operatively, and at last follow-up period. Neurological findings (Frenkel classification) and pain score (Denis pain score) were evaluated at serial follow up.  All patients were followed up for a minimum of 6 months.

Results: No patients exhibited an increase in neurological deficit. A statistically significant difference existed between the patient’s preoperative, postoperative and follow up anterior body compression, vertebral kyphosis and regional kyphosis. The mean immediate post-operative Corrections of AVBCP, vertebral kyphosis and Regional kyphosis was 42 %, 11.43º±1.06º and 12.01º±0.87º, respectively. The mean losses of correction at follow-up period were 0% , 1.5°and 1º for AVBCP , vertebral kyphosis, and regional kyphosis respectively. At the last follow-up, there was no significant loss of correction of kyphosis, whereas loss of correction of AVBCP was not significant . The final parameters at the latest follow-up period compared to the preoperative value were significantly improved (p<.001). There were 2 cases of screw loosening which did not progress to angulation.

Conclusions:  Although long-term follow–up evaluation needs to be verified, the short-term follow-up results suggest a favourable outcome for short-segment pedicular fixation with intermediate screws is safe and effective in the surgical treatment of thoracolumbar and fractures who were co-operative with 3 -4 months bracing. It provides significant correction of Vertebral body height, vertebral kyphosis, and regional kyphosis angle