Clinical and Radiological Outcome of Thoracolumbar Fractures Treated by Transpedicular Fixation

Abstract

Background: The injuries involving the spinal cord are generally challenging to manage. The aim of this study was to analyze and compare the clinical including neurological and radiological outcome of thoracolumbar burst fractures treated by short segment and long segment transpedicular instrumentation and posterolateral fusion. Methods: 34 patients with or without neurological deficit were studied. Gaines scoring, American Spinal Cord Injury Association impairment scale was used for study. Results: The mean intra-operative correction of K-angle in the short segment group was 14.68° and the loss of correction observed at the last follow-up evaluation was 6.62° with a final gain of 8.06°. The mean intra-operative correction in the long segment group was 19.76° and the loss of correction observed at the last follow-up evaluation was 6.61°. Final gain was 13.15°. On radiological evaluation of wedge angle, mean correction loss of 3.87 degrees and 3.4% implant failure was noted in the short segment group while the long segment group had 1.53 degrees of mean correction loss and no implant failure. There was no positive correlation found between Gaines score with progression of deformity. Neurological Outcome in the short segment group four grades of improvement was found in 1 patient, three grades in 1 patient, two grades in 2 patients and one grade in 6 patients. In the long segment group, three grades of improvement were found in 3 patients, two grades in 2 patients and one grade in 2 patients. 1 of the grade D patient showed improvement within the grade and 3 patients did not show any improvement. Average ASIA motor score improved with treatment from 28.31 to 39.56 points (11.25 points) in short segment group and from 19.91 to 28.46 points (8.55 points) in long segment group. Conclusion: Transpedicular fixation is a stable, reliable and less surgically extensive construct for addressing thoracolumbar burst fractures. About 6-8° loss of correction was observed with both short and long segment stabilizations in our study. Long segment has better results in terms of maintenance of reduction and final gain. The length of instrumentation does not seem to have any effect on the neurological outcome. Key Words: Thoracolumbar fractures, Clinical, Radiological outcome.