Posterior short segment fixation including the fractured vertebra in unstable burst fractures of thoracolumbar region in Nepal

Abstract

The objective of this study was to observe the outcome of short segment fixation of the unstable burst fracture in the thoracolumbar region. The study was conducted on 30 patients (age: 21-50 years) from February 2019 to August 2020 with thoracolumbar burst fracture (T10–L2). In Magerl Type A fractures, all underwent posterior pedicle screw fixation, including the fractured vertebra. The functional evaluation was done by Visual Analogue Score (VAS), Oswestry disability index (ODI), ASIA grade and radiologic parameters (Cobb angle, the kyphotic deformation and vertebral height) were recorded immediately preoperatively and at 3, 6 and 12 months then yearly. The presence of screw pullout, screw breakage, rod breakage and peri-implant loosening were evaluated as implant failure. Most of the fractures resulted from falls (21 cases), and the remaining from the road traffic accidents (9 cases). The fractured level was L1 in 13 patients, T12 in 9 patients, L2 in 6 patients and T11 and T10 in 2 patients. The modified Mcnab criteria were excellent in 18 cases, good in 11 cases and poor in 1. All patients showed improvement in mean kyphotic angle. Their pre-operative, post-operative and final follow-up mean kyphotic angle were 13.5±6.3, 13.4±4.3, 8.5±6 degrees, respectively. The average loss of kyphosis correction was 6.4±5.2° at the final follow-up. The pre- and post-operative kyphotic deformity of the vertebral body were 5.1±3.2, 4.8±2.3 and at final follow-up was 4.5±4.0 (p>0.05). Both posterior and anterior vertebral height improved significantly post-operatively with no significant loss of height at final follow-up. Functional outcomes mean ODI was 17.4% and VAS score was 1.7 at the end of one year. No complications were seen postoperatively and at final follow-up. In conclusion, short-segment pedicle screw fixation, including fractured vertebra was capable of reducing and maintain the reduction of unstable burst fractures of the thoracolumbar region.