Comparing the Efficacy of Short-segment Transpedicular Stabilization with and without Intermediate Screw for Unstable Thoracolumbar Fractures

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 16-21 | Mohan N S, Shankaragouda R Patil, Avinash Parthasarathy

Authors: Mohan N S [1], Shankaragouda R Patil [1], Avinash Parthasarathy [1]

[1] Department of Spine, Sanjay Gandhi institute of Trauma and Orthopaedics, Jayanagar East, Bangalore, India.

Address of Correspondence
Dr. Avinash Parthasarathy,
Dept. of Orthopaedics, Sanjay Gandhi institute of Trauma and Orthopaedics,
Jayanagar East, Bangalore 560011,Karnataka,India.


Objectives: Clinical outcome of thoracolumbar unstable fracture treated by short-segment transpedicular fixation with and without intermediate screw fixation assessed by modified Macnab criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI) and to compare the radiological outcome using Cobb angle, Beck index, and kyphotic deformation.
Methods: A prospective study of 60 patients with unstable thoracolumbar fracture was treated with posterior transpedicular screw fixation at Spine injury Centre, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru, from December 2016 to July 2019. Clinical assessment was done using Macnab criteria, ODI, and VAS scoring system and radiological assessment was done using Cobb angle, becks index, and segmental kyphotic deformation. The patients were divided into two groups according to the surgical method used. In Group A, 28 patients underwent surgery with a posterior approach through transpedicular screw instrumentation with an additional screw at the fractured vertebrae. In Group B, 32 patients were received a traditional short-segment fixation (1 level above and 1 level below the fractured level). Clinical and radiologic parameters were evaluated before surgery and at 3 and 6 months and 1 year after surgery.
Results: Our study showed predominant male population (80%) of working age group (21–40 years), who had unstable thoracolumbar fractures. The most common mode of injury was fall from height (60%). Majority of the patients had L1 vertebra fracture of about 48% and 28% of T12 vertebra fracture. According to modified Macnab criteria, majority have good results at 3, 6, and 12 months of follow-up, at the end of 12 months, both groups have 50% and 68% good result and 50% and 28% of excellent results, respectively, but non-significant. Mean ODI after 1 year of follow-up shows 6.93 and 8.53 and VAS score at the end of 12th month of follow-up is 1.21 and 1.22, respectively. Both groups have better Cobb angle correction from 18.39° to 10.29° in Group A and 19.25° to 11.38° in Group B. Loss of Cobb angle correction is 2.97 Group A and 2.91 in Group B. Our study shows that there is no statistically significant improvement in Beck index in both groups from 0.64 to 0.78 in Group A and in Group B from 0.62 to 0.78. Both groups have better kyphotic deformation correction from 15.71° to 7.93° in Group A and 15.22° to 8.41° in Group B and it shows that Group A has more correction of kyphotic deformation.
Conclusions: Pedicle screw placement into the fractured vertebra in management of unstable thoracolumbar is safe and feasible. Pre-operative evaluation of pedicle dimension would be useful for the placement into fractured vertebra. Short-term benefits of placing pedicle screw into fractured vertebra are restoration of vertebral body height and kyphotic angle and indirect canal decompression.
Keywords: Thoracolumbar fracture, Short segment, Cobb angle, Transpedicular fixation, Kyphotic deformation, Additional screw, Burst fracture.


1. Ravikanth M, Babu TV, Chandrasekaran A. Comparison between short and long segment transpedicular fixation of thoracolumbar burst fractures. J Evid Based Med Healthc 2016;3:996-1001.
2. Joaquim AF, Patel AA. Thoracolumbar spine trauma: Evaluation and surgical decision-making. J Craniovertebr Junction Spine 2013;4:3-9.
3. Tiryaki M, Gergin YE, Kendirlioglu BC, DEMIR H, Çine HS. Thoracolumbar fractures: Should they be operated according to thoracolumbar injury classification and severity score (TLICS). J Turk Spinal Surg 2016;27:153-8.
4. Ozdogan S, Ozturk E, Altunrende ME, Savrunlu EC, Navruz Y, Çetin E, et al. Traumatic thoracolumbar fractures: Analysis of clinical series. J Turk Spinal Surg 2016;27:225-8.
5. Siebenga J, Leferink VJ, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, et al. Treatment of traumatic thoracolumbar spine fractures: A multicenter prospective randomized study of operative versus nonsurgical treatment. Spine 2006;31:2881-90.
6. Alanay A, Acaroglu E, Yazici M, Oznur A, Surat A. Short-segment pedicle instrumentation of thoracolumbar burst fractures: Does transpedicular intracorporeal grafting prevent early failure? Spine (Phila Pa 1976) 2001;26:213-7.
7. Cho DY, Lee WY, Sheu PC. Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation. Neurosurgery 2003;53:1354-61.
8. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8:817-31.
9. Mahar A, Kim C, Wedemeyer M, Mitsunaga L, Odell T, Johnson B, et al Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976) 2007;32:1503-7.
10. Müller U, Berlemann U, Sledge J, Schwarzenbach O. Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: Bisegmental stabilization with monosegmental fusion. Eur Spine J 1999;8:284-9.
11. Payer M. Unstable burst fractures of the thoraco-lumbar junction: Treatment by posterior bisegmental correction/fixation and staged anterior corpectomy and titanium cage implantation. Acta Neurochir (Wien) 2006;148:299-306.
12. Yang M, Wang X, Li J, Xiong G, Lu C, Lu G. Implanting pedicle screw in fractured vertebra results in no adverse effect on bone healing in thoracic or lumbar burst fracture. Turk Neurosurg 2013;23:778-82.
13. Eno JJ, Chen JL, Mitsunaga MM. Short same-segment fixation of thoracolumbar burst fractures. Hawaii J Med Public Health 2012;71:19-22.
14. Gurwitz GS, Dawson JM, McNamara MJ, Federspiel CF, Spengler DM. Biomechanical analysis of three surgical approaches for lumbar burst fractures using short-segment instrumentation. Spine 1993;18:977-82.
15. Guven O, Kocaoglu B, Bezer M, Aydin N, Nalbantoglu U. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech 2009;22:417-21.
16. Defino HL, Scarparo P. Fractures of thoracolumbar spine: Monosegmental fixation. Injury 2005;36 Suppl 2:B90-7.
17. Lehman RA Jr., Lenke LG, Keeker KA, Kim YJ, Cheh G. Computed tomography evaluation of pedicle screws placed in the pediatric deformed spine over an 8-year period. Spine 2007;32:2679-84.
18. Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Jiont Surg Am 2000;82:1458-76.
19. Ye C, Luo Z, Yu X, Liu H, Zhang B, Dai M. Comparing the efficacy of short-segment pedicle screw instrumentation with and without intermediate screws for treating unstable thoracolumbar fractures. Medicine (Baltimore) 2017;96:e7893.
20. Huang W, Luo T. Efficacy analysis of pedicle screw internal fixation of fractured vertebrae in the treatment of thoracolumbar fractures. Exp Ther Med 2013;5:678-82.
21. Yu SW, Fang KF, Tseng IC, Chiu YL, Chen YJ, Chen WJ. Surgical outcomes of short-segment fixation for thoracolumbar fracture dislocation. Chang Gung Med J 2002;25:253-9.

How to Cite this article: Mohan N S, Patil SR, Parthasarathy A | Comparing the Efficacy of Short-segment Transpedicular Stabilization with and without Intermediate Screw for Unstable Thoracolumbar Fractures | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 16-21.

                                          (Abstract    Full Text HTML)      (Download PDF)

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *