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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.
E-mail: dravinash.ortho@gmail.com


Abstract

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.


References

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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)


Study of Functional and Radiological Outcome of Short-Segment Pedicle Screw Fixation for Thoracolumbar Fractures with use of Pedicle Screws in Fractured Vertebrae

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 7-15 | Mrinal B Shetty, Vinayak Venugopal, Jabez Gnany


Authors: Mrinal B Shetty [1], Vinayak Venugopal [1], Jabez Gnany [1]

[1] Department of Orthopaedics, Father Muller Medical College, Kankanady, Mangalore, Karnataka

Address of Correspondence
Dr. Vinayak Venugopal,
Department of Orthopaedics, Father Muller Medical College, Kankanady, Mangalore, Karnataka
E-mail: vinu.scorpio@gmail.com


Abstract

Purpose: The treatment of fracture-dislocations and unstable fractures of the thoracic and lumbar spine has been controversial. Many authors have advised conservative treatment which was labor intensive and associated with complications, increased bed occupancy, increased cost of therapy, increased hospital stay hours, and care by trained personnel. Early surgical indirect decompression with instrumentation reduces the duration of hospital stay, facilitates early recovery, and prevents prolonged morbidity, so there is an urgent need for possibilities of surgical stabilization, early mobilization, and rehabilitation of patients. The surgical decompression can be done anteriorly, posteriorly, or anteroposteriorly. With advent of pedicle screws, more and more fractures are treated with posterior based surgeries with long-segment (LS) fixation which regains spinal alignment and provides adequate stability. Short-segment pedicle screw fixations of thoracolumbar fractures excluding screw fixation at the fractured vertebrae do not provide the necessary stability; hence, additional fixation point with screws in the fractured vertebrae is useful and a safe technique in the treatment of thoracolumbar fractures.
This prospective study aims at comparing the clinical, radiological, and neurological outcomes after surgical decompression and instrumentation by posterior and transpedicular approach in thoracolumbar spinal fractures postoperatively at 1month, 6 months, and 1 year follow-up periods.
Materials and Methods: Adult patients with acute thoracolumbar injuries admitted to Spine Surgery unit, Father Muller Medical Hospital, Mangalore, were taken for this study after obtaining their informed, valid written consent. This is a prospective study from September 2016 to August 2018.
Results: In our study, 50% of population belong to the age group of 31–50 years, 28% belong to the age below 30 years, and 22% belong to the age above 50 years and 92% of population were male and the rest 8% were female. Twenty-nine of them sustained L1 flexion distraction injury which accounts to about 58% of the fracture, the second most common being six patients with D12 flexion distraction injury which accountsfor10% of cases. Three cases each of D11, L2, and L3 flexion distraction injury which accounts for 6% of fracture. One each case of D11 unstable burst fracture, D12 chance fracture, D12 unstable burst fracture,L1 unstable burst fracture, L1 chance fracture, and L3 unstable burst fracture which accounts for 2% of total fractures. Thirty-eight patients had no neurological deficits and categorized under the American Spine Injury Association (ASIA)-E which accounts for 76% of the cases. Seven had neurological deficits, incomplete categorized under ASIA-C which accounts for14% of the cases. Five were categorized under ASIA-D which accounts for 10% of total cases. Preoperatively, an average of 40.09% of vertebral body height was lost which improved in immediate post-operative period to 70.25% and maintained at 70.38% at the end of 1 year. Degree of segmental kyphosis preoperatively was 15.32°, which improved to 6.62° at the end of 1 year. Percentage of canal compromise measurement preoperatively showed an average of 30.38% of spinal canal encroachment. Immediate post-operative assessment showed decompression of canal to 12.64% and 10.00% at the end of 1 year. Preoperatively, an average Oswestry Disability Index score was 44.28% which improved inimmediate post-operative period to 32.52% and15.71% at the end of 1 year which is mildlevel of disability. Preoperatively, average visual analog score was 7 which shows moderate-to-severe pain which improved to 2.92, indicating minimal or no pain at the end of follow-up.
Conclusion: The technique of short-segment pedicle screw fixation with screws in fractured vertebrae is safe as our study did not show worsening of the pre-operative neurological status in any patients with ASIA-C and above. There was adequate indirect decompression of the spinal canal using smaller incision, resulting in lesser operative time, and blood loss. The vertebral body height was satisfactorily reconstructed, kyphotic angle reduced, and the spinal alignment was maintained. The final outcome in terms of improvement of ASIA impairment scale was determined by the initial injury. Incomplete injuries improved by at least one scale as per ASIA. Hence, this is an effective and safe technique which retains the biomechanical stability as compared to the LS fixation while requiring smaller incision, lesser operative time, and less blood loss.
Keywords: Short-segment pedicle screw fixation, Thoracolumbar fracture, Tanspedicular instrumentation.


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How to Cite this article: Shetty MB, Venugopal V, Gnany J | Study of Functional and Radiological Outcome of Short-Segment Pedicle Screw Fixation for Thoracolumbar Fractures with use of Pedicle Screws in Fractured Vertebrae | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 7-15.

                                          (Abstract    Full Text HTML)      (Download PDF)