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- Title
Outcome of Short Same-Segment Fixation of Thoracolumbar Burst Fractures Using Pedicle Fixation at the Fracture Level.
- Authors
Nadeem, Umair; Javed, Shahzad; Ahmed, Naeem; Zaman, Atiq Uz; Aziz, Amer
- Abstract
Introduction: Preservation of as many motion segments as possible is highly desirable with spinal fixation for trauma. This could be possible with traditional short segment posterior fixation, but it was found to have high incidence of implant failure and poor functional outcome. Short segment posterior fixation with transpedicular screw fixation at the level of the fracture (Short Same-Segment Fixation) is reported to provide a number of biomechanical advantages: better maintenance of kyphosis correction and decreased risk of implant failure. However, how much of that holds true in clinical terms, remains to be seen. Methods: A retrospective review of 71 thoracolumbar burst fractures treated with short same-segment fixation at Ghurki Trust Teaching Hospital, Lahore was done from January 2013 to December 2015. Patients presenting with thoracolumbar spinal trauma were initially treated following ATLS protocol. Thorough radiographic evaluation was done including CT and MRI. After informed consent, short same-segment fixation of burst fractures was done using locally made titanium mono-axial transpedicular screws. Outcome was measured in terms of incidence of hardware failure and loss of kyphosis correction within the follow-up period. Long-term function was assessed using Oswestry Disability Index. Results: Mean age was 34.2 ± 12.65 with 53 (74.6%) males and 18 (25.4%) females. Average duration of the follow-up was 18.23 months (range 4 to 37 months). Three patients (4.2%) presented with implant failure or pseudoarthrosis. Mean pre-operative kyphosis was 16.8°. Mean post-operative kyphosis was -1.63° (lordosis). Average loss of kyphosis correction from post-operative time to last follow-up was 13.5° (P < 0.0001). At one month follow-up, average Oswestry Disability Index score was 58.7% (range 22% to 91%). At last follow-up, the average score improved to 6.2% (range 1% to 19%). Two patients were lost to follow-up. Conclusions: Although not as favorable for maintenance of kyphosis correction, short same-segment fixation of thoracolumbar burst fractures using transpedicular fixation at the fracture level results in a low rate of hardware failure. Moreover, long-term disability and pain is considerably reduced.
- Publication
Global Spine Journal, 2018, Vol 8, p362S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771072