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- Title
Outcome of patients undergoing posterior spine fixation and decompression for posttraumatic thoracolumbar spine fractures and the factors predicting it.
- Authors
Jose, Geo Paul K.; Abraham, Tinu Ravi; Balakrishnan, P. K.; S., Irphan Muhammed P.; Haris T. P.; Prakashbhai, Vala Parth
- Abstract
Background: Posterior spine fixation and decompression for thoracic and lumbar spine fractures have the advantage of stabilization of the fracture, decompression of neural canal, early mobilization and rehabilitation of the patient. The study aimed to find out the postoperative outcome and complications following posterior spine surgery and the factors affecting the outcome. Methods: A retrospective study was carried out among 44 patients who underwent posterior spine decompression and fusion for thoracic and lumbar spine fracture. The data regarding patient presenting symptoms, comorbidity, associated injuries and imaging finding in CT and MRI were collected. The postoperative outcome of patients after surgery was assessed using ASIA impairment scale, KPS, VAS scale for pain are noted at the preoperative and postoperative period. Other factors like improvement of bowel and bladder symptoms, back stiffness and return to the job after surgery were also found out. Results: There was a significant improvement in ASIA impairment scale (mean =0.74 grade), KPS score (mean = 40) and VAS pain scale (mean = 6.7) at 6 months follow up after surgery. Improvement in ASIA impairment scale was more in the patient with severe canal compromise (mean = 1.62 grade), patients with translational/ distraction injuries (mean= 1.01grade) and patients with paraparesis (mean=1.06). Only onethird of patients with bowel and bladder involvement improved after surgery. Around 56.8% of patients were able to return to jobs at 6 months follow up. Patients who were paraplegic at the initial presentation were mostly not able to return to jobs. The most common reported complication in the study was intraoperative pedicle breakage. Conclusion: Decompression of the spinal cord plus posterior spine fixation is a safe, reliable and effective method in the management of thoracic and lumbar fractures with significant improvement in outcome in terms of motor power, pain and quality treatment for these fractures ranges from conservative management with thoracic lumbar corset to surgical management with anterior/posterior instrumentation for fixation plus decompression1,2. Surgical management for these fractures has the advantage of stabilization of fracture with fixation, decompression of neural canal, early mobilization and rehabilitation of the patient3. Though there are both anterior and posterior approaches for thoracolumbar spine fractures most spine surgeons advocate posterior fusion and decompression as the treatment of choice for unstable fractures as the approach is less extensive1,4,5. Various posterior stabilization procedures are there which include hooks, wires, transpedicular screw and rod fixation, of which transpedicular screw and rod fixation is the preferred technique now6. In traumatic spine fractures the outcome following posterior spine decompression and fusion depends on various factors which includes timing of surgery, patient comorbidities, general condition of the patient, associated injuries. The outcome following the surgery is measured based on the extend of pain relief, to be able to mobilize the patient early, return to work, neurological recovery and development of any postoperative complications. This study was done to find out the factors affecting the post-operative outcome following posterior spine decompression and fusion surgery in patients with traumatic thoracolumbar spine fractures. The study also aimed to find out the postoperative outcome and complications following posterior spine surgery.
- Subjects
SURGICAL decompression; SPINAL surgery; VERTEBRAL fractures; EARLY ambulation (Rehabilitation); SURGICAL complications; THORACIC vertebrae; SPINE; LUMBAR vertebrae
- Publication
Romanian Neurosurgery, 2021, Vol 35, Issue 4, p457
- ISSN
1220-8841
- Publication type
Article
- DOI
10.33962/roneuro-2021-077