Thoracolumbar fractures treated by unilateral pedicle screw fixation at the level of fractured vertebra

Abstract

Objective To study the feasibility and clinical efficacy of internal fixation of thoracolumbar fractures by unilateral pedicle screw fixation at the level of the fractured vertebra.Methods From January 2005 to December 2010,98 patients with single level thoracolumbar fracture were admitted to our hospital for surgery.They were 66 men and 32 women,with an average age of 44.9 years (from 19 to 65 years).Of them,50 cases were treated by unilateral pedicle screw fixation at the level of fractured vertebra and 48 cases by short segmental pedicle screw fixation.The operative time,intraoperative blood loss,postoperative cobb' angle,anterior and posterior margin heights of fractured vertebra and internal fixation failure were compared between the 2 groups.Results The patients were followed up for 6 to 53 months (mean,34months).There were no significant differences between the 2 groups in operative time or intraoperative blood loss (P ＞ 0.05).Compared with preoperation,the postoperative cobb' angle and anterior margin height of fractured vertebra were significantly improved in both groups and the improvements in the unilateral pedicle screw fixation group were significantly larger than in the short segmental pedicle screw fixation group (P ＜0.05),but there was no significant difference regarding the posterior margin height between preoperation and postoperation (P ＞ 0.05).Losses in cobb' angle and anterior height occurred in both groups at the follow-up 24 months postoperation.There were significant differences regarding losses in the cobb' angle and the anterior margin height of fractured vertebra (P ＜ 0.05) but there was no significant difference regarding the posterior margin height between the 2 groups (P ＞ 0.05).In the unilateral pedicle screw fixation group,one case of implant loosening happened,while in the short segment pedicle screw fixation group there were 3 cases of implant loosening and 3 cases of implant failure.Conclusion The unilateral pedicle screw fixation at the level of fractured vertebra can achieve better outcome in reduction and stability than short segment pedicle screw fixation in treatment of thoracolumbar fractures. Key words: Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal; Pedicle