DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20192075

Outcome of fractures of dorso lumbar spine treated by short segment posterior stabilization with intermediate pedicle screws

N. Manikandan, Babu Aloy

Abstract


Background: Spine fractures are common in today’s world due to high frequency of motor vehicle accidents and work place injuries. These are major cause of disability in adult population. The mortality rate following spinal injuries is 7%. The aim of the study was to study the functional and radiological outcome of fractures of dorso lumbar spine treated by short segment posterior stabilization with intermediate pedicle screws.

Methods: Dorso-lumbar fractures with intact pedicle on the fractured segment, Load sharing classification score of equal or less than 6, Neurologic involvement caused by the fracture, loss of vertebral body height by more than 50% and kyphosis angle more than 20° are included. Patients with multiple level fractures and pathological fractures were excluded from the study. Denis classification and AO classification were used. Load sharing score is used to decision making for intermediate screw fixation.

Results: L1 is more frequently fractured followed by D12. Distraction type (AO) and burst (Denis) are most common types. 4 of our patients had complete neurological deficit. 15 had incomplete deficit and 11 patients doesn’t have any neurological involvement. Frankel A grade cases remained in the same grade. Mean Kyphotic correction is 6.7°. Mean AVBCP in the postoperative cases 26. None of the cases developed kyphosis or loss of correction in the follow up. Outcome using Roland Morris disability questionnaire is excellent in 64.3%, good in 21.6% and poor in 14.3% cases.

Conclusions: To conclude that short segment posterior stabilisation with intermediate screws provides better biomechanical stability when compared with conventional short segment fixation.


Keywords


Thoracolumbar junction, Intermediate screws, Loads sharing classification, Kyphotic angle

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References


DeWald RL. Burst fractures of the thoracic and lumbar spine. Clin Orthop Relat Res. 1984;189:150–61.

Denis F. The three 7 column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8:817–31.

Knop C, Blauth M, Bühren V, Arand M, Egbers HJ, Hax PM, et al. Surgical treatment of injuries of the thoracolumbar transition. Unfallchirurg. 1999;102:924–35.

White AA, Panjabi MM. Clinical Biomechanics of the Spine. Philadelphia, PA, Lippincott, 1978.

Whitesides TE. Traumatic kyphosis of the thoracolumbar spine. Clin Orthop. 1977;128:78-92.

Edwards CC, Levine AM. Fractures of the lumbar spine, in Evarts CM (ed):Surgery of the Musculoskeletal System (2nd ed). New York, NY: Churchill Livingstone; 1990: 2237-2275.

Denis F, Armstrong GWD, Searls K, Matta L. Acute thoracolumbar burst fractures in the absence of neurologic deficit: A comparison between operative and nonoperative treatment. Clin Orthop. 1984;189:142-9.

Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma: An overview. Indian J Orthop. 2015;49(1):72-82.

Benson DR, Burkus JK, Montesano PX, Sutherland TB, McLain RF. Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne. J Spinal Disord. 1992;5:335–343.

Tian. Posterior Short-segmental Fixation Combined With Intermediate Screws vs Conventional Intersegmental Fixation for Monosegmental Thoracolumbar Fractures. 2011;34;8;389-96.

Farrokhi MR, Razmkon A, Maghami Z, Nikoo Z. Inclusion of the fracture level in short segment fixation of thoracolumbar fractures. Eur Spine J. 2010;19(10):1651-6.

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(14):1503–7.

Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJ, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine:a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa 1976). 2004;29(7):803-14.

Wang H, Ma L, Yang D, Wang T, Yang S, Wang Y, et al. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion. Medicine (Baltimore). 2016;95:e4443.