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Radiological Outcomes of Short Segment Pedicle Screw Fixation with Intermediate Screws at Fracture Level for Treating Thoracolumbar Fractures
Keywords:
Thoraco-lumbar spine, spinal fractures, vertebral fractures, pedicle screws, short segment, posterior spinal instrumentation, PakistanAbstract
Objective: To report radiological outcomes of short segment posterior fixation with screws in intermediate vertebra.
Methods: This descriptive retrospective study was conducted in Nishtar Hospital Multan from January 2020 to July 2021. Patients with thoraco-lumbar spine (T10-L2 vertebra) burst fractures who underwent short segment posterior fixation with screws in fractured vertebra were included. Radiological outcomes in terms of Cobb angle and anterior vertebral height on pre-operative, immediate post-operative and 1-year follow-up x-rays were calculated and compared using paired sample t-test.
Results: This study included 40 patients (32 males and 8 females) with a mean age of 33.47±13.33 years. Majority of cases involved fracture of D12 vertebra (45%). The mean preoperative kyphotic angle according to Cobb’s method was 24.58° ± 3.4° which showed significant improvement to 6.6° ± 1.33° following instrumentation (p<0.0001). The average preoperative vertebral height was 59.48% which improved significantly to 88.7% (p<0.0001). However, at final follow-up, there was loss of correction which was evident in terms of increased Cobb angle to 9.7° and loss of anterior vertebral height to 79%. The difference between pre-operative and follow-up measurements for both Cobb angle and anterior vertebral height was significant (p<0.0001). There were no incidence of implant failure or screw pull-out.
Conclusion: The results of this study demonstrate short segment posterior spinal instrumentation with screws in fractured vertebra provide excellent correction of kyphotic deformity.
References
Zileli M, Sharif S, Fornari M. Incidence and Epidemiology of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations. Neurospine. 2021;18(4):704-12.
Aly TA. Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis. Asian spine journal. 2017;11(1):150-60.
Guduru AV, Keerthi I, Sujir P, Jain MK, Sodavarapu P. Effect of pedicle screw placement into the fractured vertebra in management of unstable thoracolumbar and lumbar fractures. International journal of burns and trauma. 2022;12(4):139-48.
Kapoen C, Liu Y, Bloemers FW, Deunk J. Pedicle screw fixation of thoracolumbar fractures: conventional short segment versus short segment with intermediate screws at the fracture level-a systematic review and meta-analysis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2020;29(10):2491-504.
Thelen S, Oezel L, Hilss L, Grassmann JP, Betsch M, Wild M. Is restoration of vertebral body height after vertebral body fractures and minimally-invasive dorsal stabilization with polyaxial pedicle screws just an illusion? Archives of orthopaedic and trauma surgery. 2024;144(1):239-50.
Mak S-YJ, Siu Y-C, Chau W-W, Lo C-Y, Ma C-M. Long segment versus short segment stabilization in thoracolumbar spine fracture: A retrospective clinical and radiological analysis. Journal of Orthopaedics, Trauma and Rehabilitation. 2023;30(1):22104917221128836.
Tammam H, Alkot A, Ahmed AM, Said E. Long- versus short-segment fixation with an index vertebral screw for management of thoracolumbar fractures. Acta orthopaedica Belgica. 2022;88(3):423-31.
Al Mamun Choudhury A, Alam MS, Jonayed S, Dastagir O, Jahan MS. Long-Segment Versus Short-Segment Pedicle Screw Fixation Including Fractured Vertebrae for the Management of Unstable Thoracolumbar Burst Fractures. Cureus. 2023;15(2):e35235.
Joaquim AF, Maslak JP, Patel AA. Spinal Reconstruction Techniques for Traumatic Spinal Injuries: A Systematic Review of Biomechanical Studies. Global spine journal. 2019;9(3):338-47.
Deng L, Zhang J, Zhou Q, Zheng Y, Hua X, Hu X, et al. Effect of the intermediate pedicle screws and their insertion depth on sagittal balance and functional outcomes of lumbar fracture. Frontiers in surgery. 2022;9:905946.
Luo ZW, Liao WJ, Sun BL, Wu JB, Zhang N, Zhang Y, et al. Short-segment fixation and transpedicular bone grafting for the treatment of thoracolumbar spine fracture. Frontiers in surgery. 2022;9:1039100.
Cabrera JP, Guiroy A, Carazzo CA, Yurac R, Valacco M, Vialle E, et al. Unstable Thoracolumbar Injuries: Factors Affecting the Decision for Short-Segment vs Long-Segment Posterior Fixation. International journal of spine surgery. 2022.
Cobb J. Outline for the study of scoliosis. Instr Course Lect AAOS. 1948;5:261-75.
Boucher H. A method of spinal fusion. The Journal of bone and joint surgery British volume. 1959;41(2):248-59.
Dick JC, Jones MP, Zdeblick TA, Kunz DN, Horton WC. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation. Journal of spinal disorders. 1994;7(5):402-7.
Akgun MY, Ulu MO, Alizada O, Ozden M, Hanci M. Transpedicular Corpectomy and Anterior Column Reconstruction for the Treatment of Traumatic Thoracolumbar Fractures. Turkish neurosurgery. 2023;33(3):398-405.
