Background : The thoracolumbar spine is vulnerable to fracture in falls or motor vehicle accidents. Thoracolumbar spine fracture can be associated with neurological deficits, long-term pain and disability. The optimal management for these injuries remains a considerable subject for research. Objectives: To evaluate short-term surgical and functional outcome of posterior short-segment fixation with implanting pedicle screw in the fractured level (short same-segment fixation) for treatment of recent single-level traumatic thoracolumbar fracture. Patients & Methods: This prospective study included 36 patients with radiologically confirmed single-level thoracolumbar fracture. Patients were evaluated preoperatively, at time of discharge, and at follow-up visit after one year clinically using the Low-Back Outcome Scale of Greenough and Fraser Score, the American Spinal Injury Association (ASIA) for neurological evaluation and the AO fracture classification for injury severity evaluation. Radiological evaluation, included calculation of the sagittal index (SI) of injured vertebral body, anterior body compression (ABC) according to Mumford’s equation and regional kyphosis using Cobb angle. All patients underwent posterior trans-pedicular screw insertions into a vertebral body one level above and below the fracture site and additional pedicle screw was inserted at the level of the fracture. Post-operative clinical and radiological evaluation were compared to the pre-operative. Results: All surgeries were conducted uneventfully within 129.7±33.9 min with mean operative blood loss of 351.4±140.5 ml. Wound infection was encountered in two patients and responded to conservative treatment. Mean duration of postoperative hospital stay, and follow-up were 17.7±4.4 days and 26.5±5.1 months, respectively. After one year, mean low back pain scores were significantly higher than preoperative and early postoperative scores and frequency of patients with excellent-good postoperative status was significantly higher at early postoperative evaluation and after one year compared to the preoperative status. Eight patients had neurological deficit, after one year follow-up; six patients were improved by one grade, while the other two cases remained stationary. Mean SI and ABC calculated at discharge and after one year were significantly higher compared to the preoperative measures. Mean Cobb angle was significantly decreased compared to the preoperative angle. Mean improvement of kyphosis angle at discharge and after one year was 60.9% and 48.1%, respectively, however, there was loss of kyphosis correction by about 4.2° after one year follow-up compared to the early postoperative finding. Conclusion: Posterior short same-segment trans-pedicular screws fixation of single-level traumatic thoracolumbar fracture provided satisfactory surgical and functional outcome with minimal loss of postoperative Cobb angle and vertebral height, without loss of more motion segments. |
