English

Abstract

BACKGROUND AND OBJECTIVES: Spinal trauma is one of the grave injuries that cause infinite morbidity and disability resulting from high energy trauma. 30-60% of all spinal injuries are concentrated in the thoracic and lumbar spine and 15-20% is associated with neurological injury. The neurological improvement is independent of treatment modality, lately consensus evolving around the world for stabilization of spine with instrumentation allowing early mobilization, prevention and limitation of neurological injury as well as restoration of spinal stability. A number of fixation systems have been advocated. The use of pedicular screws and rod system allows adequate 3 dimensional control of each motion segment and allows rigid fixation. Acceptable results have been reported in majority of patients treated with pedicle screw and rod system with good neurological recovery. The aim of the study was to access the commonest mode, level, type of fracture, efficacy of pedicle screw and rod system and the radiological, neurological and functional out come in order to recreate a stable pain free spinal column. METHODS: This study is a prospective clinical study of unstable thoracolumbar spinal injuries by posterior instrumentation (pedicular screw and rod fixation in thoracic, lumbar, and thoracolumbar spinal fractures). In all, a total of 21 cases were evaluated and assessed during the period from 1st June 2008 to 30th September 2010. The study was conducted in the Department of Orthopaedics, Vijayanagara Institute of Medical sciences, Bellary. Patient selection was according to the inclusion and exclusion criteria and was surgically treated with pedicle screw and rod system. RESULTS: In our series there were 20(94.75%) males and 1(5.25%) female patient with an average age of 28.3 years 17(82.1%) cases due to fall from height, 4(17.9%) cases following road traffic accident.16(76.1%) cases were of AO Type A, 3 (14.2%) of AO Type B, 2(9.52%) of AO type C fractures. All patients were of ASIA grade A, B, C on admission and 9(42.8%) showed improvement to ASIA grade D, E at three months and 13(62%) showed improvement ASIA grade D, E at latest follow up. Good Functional outcome with pain relief achieved in 12(57%) of cases. Fair results in 8(38%) cases, and poor results in 1 (5%). CONCLUSION: Management of thoracic and lumbar spine fractures requires careful preoperative planning, patient selection, neurological evaluation and meticulous intraoperative care and post-operative rehabilitation for good functional outcome. Pedicle screw and rod fixation should be done as early as possible in order to facilitate neurological recovery, help in good nursing care and early mobilization of the patient and to prevent deterioration of the neurological status. Pedicle screw instrumentation provides less surgical exposure, correction of deformity and better stabilization of one motion segment above and below the fracture. The administration of pre-operative steroids have shown to have a beneficial effect on the final neurological outcome. Early surgical intervention helped in good neurological recovery.