Outcomes of Short Segment Posterior Instrumentation in Unstable Thoracolumbar Fractures

Abstract

Introduction: The spinal traumas are common and leading problem in orthopaedics practice. The individuals are at a risk of high energy trauma in modern era. Unstable thoracolumbar burst fractures are serious injuries of concern, if left untreated may result in marked morbidity and disability to the patient. Thoracolumbar is the second most common segment involved in the spinal cord following spinal injuries followed by cervical segment. The goal of treatment of any spinal injury is restoration of the patient to maximum possible function with disability free life. Aim: To analyse the outcomes of unstable thoracolumbar burst fractures stabilized with short segment posterior instrumentation with transpedicular screws. Materials and Methods: This prospective interventional study consisted of 32 patients with unstable thoracolumbar burst fractures carried out at Department of Orthopaedics, New Civil Hospital, Surat during Jan 2014 to Dec 2015. We stabilized the patients with unstable thoracolumbar spinal fractures with short segment posterior instrumentation by using the intermediate screw option in the fractured vertebra level as a method of augmentation. Patients were evaluated for maintenance of spinal correction and neurological improvement after short segment posterior instrumentation in unstable thoracolumbar burst fractures. Results: The mean age for males was 35.57 ± 11.62 years and for females was 33.56 ± 11.2 years. The most common vertebra involved in the study group was T12 (31.25%). In the study, about 66% patients had a fall from height as the mode of injury, whereas 34% injuries were due to road traffic accident. In the study group, the mean regional angle observed during pre-operative stages was 16.0°±5.1°. There was a statistically significant (p<0.05) difference between pre-op and post-operative regional angles as well as anterior wedge angles. There was a statistically significant difference (p<0.05) in the vertebral height between pre-operative and post-operative stages. Conclusion: Short segment posterior instrumentation is a very stable implant construct in maintenance of deformity correction and fracture reduction along with the added advantage of sparing of the motion segments.

Keywords

• asia grading
• burst fractures
• intermediate screws
• thoracolumbar trauma
• transpedicular screws