A Prospective Study on the Management of Fractures of Thoracolumbar Spine With Pedicle Screw Fixation

Dr. Prasad M. Gowda; Dr. Mohan M. Krishna; Dr. Nabeel Mohammed

Volume : IV, Issue : IX, September - 2014

A Prospective Study on the Management of Fractures of Thoracolumbar Spine With Pedicle Screw Fixation

Dr. Prasad M. Gowda, Dr. Mohan M. Krishna, Dr. Nabeel Mohammed

Abstract :

Background: The thoracolumbar junction is the most common area of injury to the axial skeleton. Forces along the long stiff kyphotic thoracic spine switch auptly into the mobile lordotic lumbar spine at the thoracolumbar junction. Goals of treatment are to obtain a painless, balanced, stable spine with optimum neurological function and maximum spine mobility. Our prospective study has evaluated the effectiveness of pedicle screw instrumentation in various fractures around the TL spine to overcome the complications encountered in the conservative line of management of these fractures. Materials & Methods: 20 cases of fractures around the thoracolumbar spine were operated with posterior pedicle screw fixation one or two level above and below the fracture. The cases were followed up for a mean of 6 months with radiological and neurological evaluation. Results: The unstable burst fractures were found to be the most common type of fracture. Radiological parameters sagittal angle and index were recorded pre and postoperatively. The neurological grading was done using the ASIA scale. Follow–up was done for a minimum of 6 months where sagittal angle reduction achieved was 5.90 ± 4.650 at final follow–up from 24.70 ± 6.68o pre–operative. The sagittal index achieved at final follow–up was 65% compared to the pre–operative mean of 48 %. The neurological improvement was regarded to be fair enough for the type of injury sustained and fixation achieved. Conclusions: We found that the application of posterior instrumentation resulted in a reasonable correction of the deformity with a significant reduction in recumbency associated complications. Neurological recovery was seen significantly when all cases with neurological deficits were clubbed together; the limiting factor being the small study group and short follow–up period.