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