Functional and radiological outcome of using long segment posterior pedicle screw constructs in unstable thoraco-lumbar fractures

Abstract

Background: The treatment of unstable thoracolumbar fracture remains controversial. Various options exist, but which approach to be used and the number of levels to be instrumented still remains a matter of debate. In this study we assess the outcome of these fractures with long segment posterior pedicle constructs alone. Methods: Study comprising of 18 patients with unstable thoraco-lumbar fractures, was conducted with inclusion criteria a)age 18- 50 yrs, b)injury – surgery duration <3 weeks and exclusion criteria a)open fractures, b)pathological fractures, c)fractures dislocations, and d) pregnant and lactating females. All patients underwent posterior decompression and stabilization with long segment posterior instrumentation using 8 pedicle screws (2 above and 2 below). The average follow-up was 18.5 months. The outcomes were analysed in terms of functional quality of life measured by ODI (Oswestry Disability Index), kyphotic angle, anterior vertebral height, duration of surgery and blood loss. Results: Mean age of patients was 32.8 yrs with majority being males (14/18) and L1 was most common vertebra involved (10/18). Mean duration of surgery was 160 minutes (range 130–195) and average blood loss was 447 ml (range 290-550). Mean preoperative ODI score was 91.88% which improved to 14.42% at final follow up. Mean kyphotic angle improved from 20.22° preoperatively to 2° in immediate post operative period and was 6.1° at final follow up. The mean pre-operative anterior vertebral height was 53.21% which improved to 90.18% after surgery and was 82.08% at final follow-up. Conclusion: The authors recommend long segment posterior pedicle instrumentation alone for unstable thoraco-lumbar fractures as it has advantage of achieving better correction with maintenance of correction and decreased failure rates as compared to short segment posterior instrumentation and substantially less morbidity and complications as compared to anterior approach or combined anterior and posterior approach.