Outcome of Long Segment Posterior Spinal Stabilization Incorporating the Fractured Vertebra for Unstable Thoraco-Lumbar Junctional Brust Fracture

Abstract

Objectives: To evaluate the outcome of long segment posterior spinal stabilization incorporating the fractured vertebra with posterolateral fusion for unstable thoraco-lumbar junctional brust fracture. Background: Thoracolumbar junction is the commonest site of traumatic spinal injury. Now a days, it is managed surgically most of the time because it is often associated with the spinal cord injury. Its mode of surgical management is a field of controversy. Huge debate is still going on between the superiority of long & short segment stabilization. In this study, we evaluated the outcome of long segment posterior spinal stabilization incorporating the fractured vertebra Materials & Method: This prospective interventonal study included 30 case of thoraco-lumbar junctional unstable brust fractures was carried out in the Spine unit of Orthopaedic surgery department of Bangabandhu Sheikh Mujib Medical University, Dhaka and other private hospital in Dhaka City, Bangladesh, from January 2016 to July 2022. All the patients with positive clinical findings, X-ray, MRI & CT scan findings and underwent long segment posterior spinal stabilization incorporating the fractured vertevra with posterolateral fusion. Average follow-up period was 12 months. Pre & Post-operatively, neurological assessment was done by the ASIA Impairment Score, improvement of pain control by VAS score, fusion rate by Bridwell’s criteria, Kyphotic angle was measured by Cobb’s angle measurement method & Overall functional assessment by modified Odom’s score. Results: Total number of patients was 30. Average age was 34 years (range 21- 47). ASIA score improved from B to C in 5 patients, B to D in 5 patients, C to D in 8 patients , C to E in 3 patients, patients, D to E in 7 patients. 2 patient did not improved following surgery. Fusion was achieved in 29 patients & 1 patient developed pseudoarthrosis. Pre & Post- operative VAS score was 7.30±1.9 & 3.3±1.8 respectively. The average kyphotic correction was 15 ∞. In our series, we have no bedridden patients after surgery. There was no radiographic progression after surgery. Conclusion: Early treatment within 21 days of injury with long segment posterior spinal stabilization incorporating the fractured vertevra with posterolateral fusion is a very effective surgical procedure with preservation of the motion segment to treat unstable thoracolumbar junctional brust fracture.