Dorsolumbar Fractures Research Articles

Dorso Lumbar Fractures Type A1 Treated by Segmental Fixation versus Conservative Treatment

Abstract Background Thoracolumbar fractures types A1 of AO classification are very common spine injuries. However, its management is usually without operative intervention especially if its patients are neurologically intact. Objective Dorsolumbar fractures are treated either with operative (posterior fixation) or conservative. The aim of this study is to compare the results of conservative versus operative treatment in a certain type of fracture (type A1 dorsolumbar fracture) regarding fracture and radiological parameters. Patients and Methods 60 patients were enrolled in the current study, 29 were males and 31 were females with a mean age of 31.300 years old in non operative patients and 33.867 years old in operative patients at time of surgery. Results Regarding radiological parameters, this study included measurements of local kyphosis angle, and vertebral body wedging. The results showed statistically significant differences between preoperative values in comparison to both postoperative and follow up values. Regarding the functional assessment scores, the mean VAS was 1.125 in non operative patients and the mean VAS was 1.040 in operative patients. The mean ODI was 10.633 % in non operative patients and about 8.700% in operative patients at the last follow up visit. There is no great difference between operative and non operative patients in VAS and ODI but there is more satisfaction in operative patients. The degree of kyphosis is more in non operative patients which made few of them in mild pain in the last follow up. The complications encountered were very few, not including any major or neurological complications. Conclusion The only purpose to do fixation on those patients of type A1 fracture is to permit early ambulation and to protect them from kyphosis. but VAS and ODI have no big difference between the two groups but more in non operative in cases suffering from post traumatic kyphosis.

Study on the Results of Laminectomy with Short Segment Pedicle Screw Fixation in Dorsolumbar Fractures with Respect to Anatomical Reduction, Functional Recovery, and Pain

Abstract Background: This study aimed to report the results of laminectomy with short-segment pedicle screw fixation in thoracolumbar fracture. Materials and Methods: Forty-two patients were analyzed prospectively, and followed up in the outpatient department for 24 months. Results: The results revealed that most of the patients in the study had reasonable to good neurological recovery in the postoperative period assessed in the form of an American spinal injury association impairment scale (ASIA) score. There was also an excellent improvement in the components of anatomical reduction like vertebral height, Cobb’s angle, and anterior wedge angle, which was directly related to the functional recovery of the patient. Postoperatively, the patients also got relief in pain in the dorsolumbar region assessed based on the Denis pain scale. Conclusion: This study concludes that laminectomy with pedicle screw fixation is an excellent option for patients with thoracolumbar fracture, it not only decompresses the spine but also provides stability with minimal manageable complications.

Study on Results of Laminectomy with Short-Segment Pedicle Screw Fixation in Dorsolumbar Fractures with Respect to Anatomical Reduction, Functional Recovery and Pain

Background: The aim of this study was to report the results of laminectomy with short-segment pedicle screw fixation in thoracolumbar fracture. Materials and Methods: Forty-two patients were analyzed prospectively, followed up in the outpatient department for the period of 24 months. Results: Most of the patients in the study had reasonable to good neurological recovery in the postoperative period assessed in the form of American Spinal Cord Injury Association (ASIA) score. There was also an excellent improvement in the components of anatomical reduction such as vertebral height, Cobb’s angle, and anterior wedge angle, which was directly related to functional recovery of the patient. Patients postoperatively also got relieved in pain in the dorsolumbar region assessed based on Denis pain scale. Conclusion: Laminectomy with pedicle screw fixation is an excellent option for patients with thoracolumbar fracture; it not only decompresses the spine but also provides stability with minimal manageable complications.

Surgical Management of High Energy Dorsolumbar Fractures

Background: The management of dorsolumbar fractures has been the subject of much controversy. There are different criteria for the choice of management based on the severity of the kyphotic deformity, canal compromise, vertebral height loss, and neurologic status. Objective:To evaluate the results of surgical management of high energy dorsolumbar fractures in the Trauma Unit at Assiut, and at Al-Azhar University Hospitals. Patients and Methods: From October 2017 to October 2019, 40 patients with thoracolumbar spine (TLS) fractures, all of them were treated by posterior instrumentation with pedicle screws and rod system. 23 petients (57.5%) underwent long-segment fixation and 17 patients (42.5%) underwent short-segment fixation. They were operated upon at the Trauma Unit of Assiut University Hospital and Al-Azhar University Hospital. Results:The clinical outcome according to modified Macnab criteria; in long segment group it was excellent in 8 patients (34.7%), good in 11 patients (47.8%), fair in 3 patients (13% ) and poor in 1 patient (4.3%), while in short segment group; it was excellent in 3 (17.6%), good in 10 (58.8%), fair in 3 (17.6%)andpoor in 1 (5.9%). The kyphosis correction (%), in long segment group was ≥70 in 16 patients (70%), <70 in 7 patients (30%), while in short segment group, it was ≥70 in 10 patients (59%) and <70 in 7 patients (41%). Conclusion: Short segment fixation using pedicle screw at the level of fracture, inhigh energy thoracolumbar fractures; provides comparable correction to long segment fixation and the amount of correction loss can be minimized by proper selection of cases suitable for short segment fixation.

Clinical and Radiological Assessment of Interbody Fusion and Short-Segment Fixation in Dorso-Lumbar Fractures

Background: Spine fractures account for a large portion of musculoskeletal injuries worldwide. Approximately 75% to 90% of spinal fractures occur in the thoracic and lumbar spine, with most of these occurring at the thoracolumbar junction (T10-L2). Surgical treatment has demonstrated better clinical and radiological results than conservative treatment. Objective: To evaluate the outcome of short-segment fixation with interbody fusion in dorsolumbar fractures clinically and radiologically. Patients and Methods: This study took place at the Neurotrauma Unit of Neurosurgery Department, Zagazig University Hospitals. It included sixteen patients with thoracolumbar fractures treated by short-segment open transpedicular posterior fixation with interbody fusion. Results: Male was the predominant sex (68.7%), mean age was 37.88 years (range: 19-55 years) and the residence in rural areas was 50 % and in urban areas was 50 %. Housewives were the predominant occupation and constitute 31.3%. 81.3% of patients were married. The most prevalent AO spine type of fracture was A3 fracture where it constituted 62.5% of patients, the level of fracture was L2 in 50 % of patients & about 38% had severe pain as reported on VAS score. In our Study there was significant change in ASIA score 12 weeks postoperatively. While 62.5% had E score preoperatively, 87.5% had it 12 weeks postoperatively and 12.5% turned had score C 12 weeks preoperatively versus no one postoperatively had C ASIA score. Conclusion: Surgical treatment of thoracic and lumbar fractures allows for immediate stabilization of the spine, restoration of sagittal alignment, and the possibility of spinal canal decompression.

Post-operative neurological outcomes in patients of dorsolumbar fractures with incomplete spinal cord injury

Background: Despite recent advances in understanding spinal mechanics, injury mechanisms, improved instrumentation, better imaging techniques and improved rehabilitative care, the management of spinal cord injury patients remain controversial. In this study we try to analyse neurological outcomes in cases of incomplete spinal cord injuries (SCI) of dorsolumbar spine treated by decompression and posterior fixation at our centre. Methods: 36 patients with incomplete SCI due to dorsolumbar fractures which were operated in our centre between May 2017 and January 2019 were included in our study. The neurological status of these cases was assessed using American Spinal Injury Association (ASIA) Impairment Scale before and after surgery and at follow ups of 1 month, 2 month, 3 month and 6 months. Results: The mean age of patients in our study was 33.7 years with most patients in 26-40 years that is the young working age group. There were 22 males and 14 females. Most common cause leading to SCI was found to be fall from height. 24 cases out of 36 showed improvement of 1 or more grades in their ASIA Impairment Scale. Conclusion: Operative fixation of dorsolumbar fractures achieves early mobilisation and rehabilitation in cases of Incomplete SCI. Our study indicates that neurological status also improves in such patients after operative fixation.

Outcome of Pedicular Fixation of Unstable Dorsolumbar Fractures

Background: The spine is made of 33 individual bones stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist as well as protecting the spinal cord from injury. Objective: The aim of this study was to evaluate the post-operative clinical outcome of transpedicular screw and rod fixation in unstable thoracolumbar fractures by using Mc Nab’s criteria in patients collected from Sohag General Hospital and Sohag University Hospital. Patients and methods: A prospective study included patients admitted to Orthopedic and Traumatology Department of Sohag General Hospital suffering from unstable fracture of thoracolumbar area. The study was conducted on twenty patients suffering from thoracolumbar fractures attending to Department of Orthopedics and Traumatology, Sohag University Hospitals, Sohag General Hospital and Al-Azhar University Hospitals from June 2018 till December 2018. Results: In comparison between cases, which conserved and those operated as regard vertebral height loss, angle of kyphosis, oswestry disability index and visual analogue score, we found that p value was not significant in these parameters and its value was 0.15, 0.46, 0.15, and 0.88 respectively. Which means that decision making correlated to patient score. As regards type of operative fixation done, there were non-significant comparison between type of fixation done and the mentioned parameters. All changes in the parameters explain that these parameters correlate with TLICS and prove the validity of this classification. Conclusion: Posterior short segment pedicle screw fixation is good and enough for treatment of thoracolumber fractures (burst fracture) when neurological condition of the patients is intact.

Outcome of Pedicular Fixation of Unstable Dorsolumbar Fractures

Outcome of Pedicular Fixation of Unstable Dorsolumbar Fractures

Outcome of fractures of dorso lumbar spine treated by short segment posterior stabilization with intermediate pedicle screws

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Spine fractures are common in today’s world due to high frequency of motor vehicle accidents and work place injuries. These are major cause of disability in adult population. The mortality rate following spinal injuries is 7%. The aim of the study was to study the functional and radiological outcome of fractures of dorso lumbar spine treated by short segment posterior stabilization with intermediate pedicle screws.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Dorso-lumbar fractures with intact pedicle on the fractured segment, Load sharing classification score of equal or less than 6, Neurologic involvement caused by the fracture, loss of vertebral body height by more than 50% and kyphosis angle more than 20° are included. Patients with multiple level fractures and pathological fractures were excluded from the study. Denis classification and AO classification were used. Load sharing score is used to decision making for intermediate screw fixation.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; L1 is more frequently fractured followed by D12. Distraction type (AO) and burst (Denis) are most common types. 4 of our patients had complete neurological deficit. 15 had incomplete deficit and 11 patients doesn’t have any neurological involvement. Frankel A grade cases remained in the same grade. Mean Kyphotic correction is 6.7°. Mean AVBCP in the postoperative cases 26. None of the cases developed kyphosis or loss of correction in the follow up. Outcome using Roland Morris disability questionnaire is excellent in 64.3%, good in 21.6% and poor in 14.3% cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; To conclude that short segment posterior stabilisation with intermediate screws provides better biomechanical stability when compared with conventional short segment fixation.&lt;/p&gt;

Sohag experience in treatment of Dorsolumbar fractures according to Thoracolumbar injury classification and severity score(TLICS)

Background:.The Thoracolumbar Injury Classification and Severity Score (TLICS) was developed to improve injury classification and guide surgical decision making, yet validation remains necessary. This study evaluates the functional ,clinical and radiological outcome of patients with thoracolumbar spine trauma (TLST) treated according to the TLICS. Aim of the work:To validate the efficacy of Thoracolumbar injury classification and severity score (TLICS) in orthopaedic emergency department at sohag university hospitals. Patients and methods:The TLICS was prospectively applied to a consecutive series of patients (30 cases) treated for TLST between October 2016 and October 2017. Patients with a TLICS score more than 4 points were surgically treated, whereas patients with a TLICS score of less than 4 points were conservatively managed.Those with a score of equal 4 ,group were managed conservatively and the other were operated.The primary outcome was the American Spinal Injury Association Impairment Scale (AIS)(1). Results:The decision taken according to TLICS either conservative if the final score 4. Conservative treatment in the form of rest and dorsolumbosacral brace .Operative in form of posterior fixation with or without decompression .Transpedicular fixation and decompression was needed in 10 cases (33.33%) because they were suffering from neurological insult.The mean age was 34years.There were a marked improvement in angle of kyphosis , vertebral height loss and Oswestry disability index .No patient had neurological worsening during the follow-up. Conclusion:.Thoracolumnar injury and severity score is valid and safe for management of thoracolumbar fractures and has good reliability.

Surgical treatment of vertebral fractures in patients with ankylosing spondylitis: a retrospective study

Background: The diagnosis of vertebral fractures in patients with ankylosing spondylitis is sometimes difficult and management should respect the nature of the disease and patient’s deformity. We aim to clarify some technical steps during diagnosis and management and analyze the possible complications. Methods: Twenty-two patients were enrolled in this study between January 2004 and December 2014. All patients were already diagnosed with ankylosing spondylitis (AS) and presented with vertebral column fractures. All patients were men with an average age of 55.9 yr. Six patients had a fractured cervical spine, one patient had a cervicodorsal junction fracture, seven had a fractured dorsal spine, and eight had dorsolumbar junction fractures. The patients were evaluated neurologically according to Frankel grading system. All patients had radiographic survey of the entire spine. CT was obtained in every patient. MRI was obtained to evaluate the neural tissues and presence of epidural hematoma. All patients required surgery to stabilize the vertebral column. Long fixation with adequate bone graft is the rule for dorsal and dorsolumbar fractures with respect to the preoperative deformity. Anterior fixation and posterior fixation were done for cervical fractures extending to more than one level. Results: All patients with cervical fractures had anterior fixation followed by posterior laminectomy and lateral mass fixation. No anterior approach or fixation was done for dorsal or dorsolumbar fractures. Five patients were admitted to the intensive care unit postoperatively. The mean follow-up period was 24.5 mo. The patients who were Frankel E postoperatively regained their preoperative level of activity. At the end of follow-up, there were no metal failures or pseudoarthrosis. Conclusions: The surgical treatment is a cornerstone with attention to the nature of the disease and the preexisting deformity of the patient.

Functional and radiological outcomes of thoracolumbar traumatic spine fractures managed conservatively according to Thoracolumbar Injury Severity Score.

Aim:To study the functional and radiological outcomes in cases managed conservatively for single-level traumatic thoracolumbar spine fractures without neurological deficit.Materials and Methods:In this prospective study design, thirty patients who presented to tertiary care hospital and diagnosed with posttraumatic thoracolumbar vertebral fracture without any neurodeficit were recruited. All the patients were managed conservatively as per the protocol which included bed rest, spinal braces, and physiotherapy. Adequate analgesia was given wherever necessary. The patients were followed at regular intervals up to a maximum of 2 years. Clinically visual analog scale (VAS) score and Roland Morris Disability Questionnaire (RMDQ)-24 were assessed and radiologically local vertebral kyphosis, scoliosis, and loss of body height were noted at each follow-up.Results:The data was statistically analyzed and the results were as follows. Thoracolumbar fractures were more in young adults (<26 years) and more so among the males (80% cases). The most common fracture type in our study was compression fracture. The most common site involved in our study was L1 vertebra (36.7%). There was a significant decrease of VAS score (pain score) in 79% cases with the maximum decrease in type A1 fracture. The mean RMDQ-4 score in our study was 5.53. The overall progression of kyphosis was 1.9°. There was no relation found between the kyphotic deformity and the clinical outcomes (VAS and RMDQ-24 scores). Canal size changes were found to be insignificant at the end of 2 years compared to baseline.Conclusion:Study showed favorable outcomes in terms of return to daily activities, making it a good option in managing Type A1 dorsolumbar fractures. Though there was a progression of kyphosis but no neurological deficit was seen.

Clinical profile of thoracolumbar spine fracture in adult

Most common site of injury was L1 vertebra. There was an increase in incidence of spinal cord injuries during summer and rainy season. All those cases of unstable dorsolumbar fractures were included in the study that fulfilled following criteria. In our series, most common type was wedge compression fractures, accounting for 56% of the cases. Next common type is burst fracture 44%.In percutaneous pedicle screw fixation group, wedge compression fracture 64% were operated, compared to 48% of conventional pedicle fixation group. Burst fractures, which constituted 36% was the in percutaneous pedicle fixation group compared to 52% of conventional pedicle fixation group. Most common type was wedge compression fracture

Posterior Spinal Fixation with Fusion versus without Fusion in Treatment of Dorsolumbar and Lumbar Fractures

Introduction Operative treatment in the form of posterior fixation with or without fusion has moved to the forefront of fracture management as it helps decreasing morbidity and mortality with better return to work and satisfactory functions. The aim of the study is to compare the results of posterior spinal fixation with fusion versus without fusion in cases of dorsolumbar and lumbar fractures both clinically and radiologically. Material and Methods A randomized clinical trial conducted on 60 patients in Ain Shams University Hospitals in two groups: Group (A): posterior spinal fixation with fusion (30 patients); Group (B): posterior spinal fixation without fusion (30 patients). All patients have dorsolumbar and/or lumbar spine fractures and are candidates for posterior spinal fixation. Inclusion criteria: Age group (&lt;45 years). Both sexes. Neurologically intact patients with kyphotic angle more than 20° or decreased vertebral body height more than 50% or a canal compromise more than 50%. Single or multilevel spinal injury. Exclusion criteria: Any patient who will need anterior fusion according to load sharing classification (≥7). Incomplete or complete neurological deficit. Advanced spondylosis. Fracture of pars interarticularis. Fracture of facet joints. Preoperative evaluation includes history, examination, and radiological evaluation. All patients were done under general anesthesia in prone position. A standard midline posterior approach was used to expose the desired levels for fixation. Posterior instrumentation using pedicular screws (in non-fusion group, only top loading rod systems were used as side loading and plate systems may damage facet joints). Posterior and intertransverse fusion was used in fusion group. Results Operative time was shorter in non-fusion group (107.5 minute) than fusion group (140.83 minute). Intraoperative blood loss was less in non-fusion group (330.33 ml) than fusion group (368.33 ml). The mean of lost correction of vertebral body height % in fusion group was 7.9 while the mean of lost correction of vertebral body height % in non-fusion group was 8.07. This is statistically not significant with P-value &gt; 0.05 (0.917). The mean of lost correction of Cobb angle in fusion group was 6.7° while the mean of lost correction of Cobb angle in non-fusion group was 8.65°. This is statistically significant with P-value &lt; 0.05. The mean segmental motion after removal in fusion group was 1.73° while the mean segmental motion after removal in non-fusion group was 11.62°. This is statistically significant with P-value &lt; 0.001. Conclusion Posterior spinal fixation without fusion yielded satisfactory results similar to those of posterior spinal fixation with fusion in patients with dorsolumbar fractures with a load sharing score &lt; 7.

Minimally Invasive Spine Osteosynthesis (MISO) Technique for Fractures Spine: A Case Series 14 Cases

Background: The choice of treatment of dorso-lumbar spinal fractures in the absence of neurological deficit depends on the classification and severity of injury. In the conventional open approach with posterior pedicle screw fixation, detachment of the Para spinal muscles may be required. In addition, this open approach may be disadvantaged by prolonged operative time, increased intraoperative bleeding and delayed functional rehabilitation. All these problems appear to encourage orthopedic surgeons to limit secondary iatrogenic insult in these patients by mini open surgery. The goal of this study is to evaluate the effectiveness of minimally invasive treatment of dorsolumbar fractures by mini open surgical pedicle screw fixation and to discuss the potential benefits and drawbacks of this procedure. Patients and methods: This is a prospective study involves 14 Patients (10 males) treated and followed between Feb. 2010 to Feb 2014. All had acute traumatic single level dorso-lumbar spine fractures, age range 17-47 years (mean 30.1 ± 7.9 yrs). Patients with pathological fractures, neurological injury, anatomical variations of the cord or vertebrae, mental illness, significant surgical contraindications, osteoporosis, refusing to sign informed consent and those with (TLICS) score ≤4 or load sharing score ≥7 were excluded from the study. All the cases had been treated by minimal invasive posterior approach. Total of 56 screws and 28 rods were applied utilizing the conventional posterior instrumentation. Results: Mean post-operative hospital stay 3.8 days. No major complications as spinal cord, nerve root or blood vessel injuries occurred. No screws were broken and just two screws were malpositioned. All patients improved clinically, and the outcome (according to modified MacNab criteria) was considered excellent in six patients, good in seven, and poor in one patient. Conclusion: Mini open surgery for posterior pedicle screws fixation has attracting increasing attention as it brings a multitude of advantages including: less bleeding, lower incidence of postoperative intractable low back pain and reduced hospitalization stay. However; some shortcomings as limited indications, unsuitability for long segment fusion and high load-sharing score patients restricts its worldwide prevalence.

Navigated pedicle screw placement using computed tomographic data in dorsolumbar fractures.

Background:Computed tomographic (CT) based navigation is a technique to improve the accuracy of pedicle screw placement. It is believed to enhance accuracy of pedicle screw placement, potentially avoiding complications arising due to pedicle wall breach. This study aims to assess the results of dorsolumbar fractures operated by this technique.Materials and Methods:Thirty consecutive skeletally mature patients of fractures of dorsolumbar spine (T9–L5) were subjected to an optoelectronic navigation system. All patients were thoroughly examined for neurological deficit. The criterion for instability were either a tricolumnar injury or presence of neurological deficit or both. Patients with multilevel fractures and distorted spine were excluded from study. Time taken for insertion of each pedicle screw was recorded and placement assessed with a postoperative CT scan using Laine's grading system.Results:Only one screw out of a total of 118 screws was misplaced with a Laine's Grade 5 placement, showing a misplacement rate of 0.847%. Average time for matching was 7.8 min (range 5-12 min). Average time taken for insertion of a single screw was 4.19 min (range 2-8 min) and total time for all screws after exposure was 34.23 min (range 24-45 min) for a four screw construct. No neurovascular complications were seen in any of the patients postoperatively and in subsequent followup of 1-year duration.Conclusion:CT-based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9-L5), however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries. Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.

Evaluation of chronic low back pain in osteoporotic patients in treatment with teriparatide

OBJECTIVE: The objective was to assess the improvement of chronic low back pain in osteoporotic patients treated with teriparatide (TPTD). METHODS: This was an observational study with a convenience sample of 21 patients with osteoporosis using TPTD, 20 mcg/day, between 2006 and 2010, with chronic low back pain (more than three months). Dorsolumbar radiographs and bone densitometry (DXA) were performed before and after treatment. For pain measurement the VAS pain scale was used. Data were entered in Excel and processed in STATA/SE 8.0 with Chi2 square or Fisher (p &lt; 0.05). RESULTS: twenty-one patients aged 40-90 (mean 70 years), eight (40%) had senile osteoporosis and thirteen (60%) had osteoporosis secondary to medications. Seventeen (80%) had previous dorsolumbar fractures. Ten (47.5%) used TPTD for 24 months, six (27.5 %) used the medication for 18 months, four (20%) for 12 months and one (5%) for six months. Eight patients (40%) received previous anti-reabsortive therapy. Thirteen patients (60%) exhibited bone mass gain between 0% and 9% while eight (40%), between 10% and 15%. The final average VAS was 2.6 representing an improvement of 4.7 (p&lt; 0.05). CONCLUSION: There was a significant reduction in the severity of low back pain with the use of TPTD (initial mean VAS: 7.3, final VAS: 2.6, improvement: 4.7).

The Role of Long Segment Posterior Fixation and Transpedicular Decompression in the Management of Thoracolumbar Fractures

Background Data: Treatment of spinal injury aims for restoration of spinal anatomy, relieving the pain and achieving stability without neurological damage. One of the recent surgical approaches to spinal cord compression is transpedicular re-impaction of retro-pulsed vertebral body fragments and/ or partial or complete corpectomy with verebroplasty and posterior fixation. Purpose: to assess the effectiveness of the transpedicular approach in spinal decompression, reconstruction, realignment and fixation. Study design: prospective clinical case study. Patient and Methods: we report on 25 patients with traumatic dorso-lumbar fracture causing anterior neural compression. Ten patients were males and 15were females. The mean age was 39.4±16.8 (range 17-60). Outcome measures: clinical outcome was assessed by visual analogue scale for pain and ASIA-Imsop scale for motor. Radiological outcome assessed canal compression, vertebralheight and kyphotic angel. All patients had been operated posteriorly, with transpedicular decompression with and without vertebroplasty. Long segment pedicle screw fixation was done in all cases. Follow up period was 12 months.Results: Significant improvement in pain and motor state was recorded in early postoperative scales that maintained in late postoperative scale. Canal compromise, vertebral height and kyphotic angel were significantly reduced.Conclusion: Transpedicular approach is an effective technique done in familiar position. It is a safe, taking relatively short time, with minimal blood loss and with few operative complications. The procedure achieved significant ventraldecompression, improved and maintained vertebral alignment. (2013ESJ048)

Anterior decompression and fixation with Webb-Morley procedure in dorsolumbar spinal injury.

To evaluate the neurological outcome of anterior decompression and fixation with Webb-Morley procedure in dorsolumbar spinal injuries. A case series study. The Neurosurgery Department, Jinnah Postgraduate Medical Centre, Karachi, from May 2008 to July 2010. Patients with post-traumatic unstable dorsolumbar spine having compression of the spinal cord with bony fragments of the fractured vertebra were included in the study. Patients below the age of 15 years and patients with bed sores and unfit for anaesthesia were excluded. Plain X-rays and magnetic resonance imaging (MRI) were done. All patients were treated for dorsolumbar fractures by anterior decompression and fixation with Webb-Morley procedure. All patients were assessed clinically by the Frankel's grading before and after surgery. Among 60 patients, 41 were males and 19 were females. Mean age was 37.2 ± 4 years. Major cause of trauma was road traffic accident. The commonest level of the fracture was at the dorsolumbar junction i.e. 71.66% (n = 43). About 19 (31.66%) patients improved to the Frankel's grade-E, while 41.66% (n = 25) improved to grade-D after surgery. There was no postoperative mortality. According to the current study, anterior decompression and fixation with Webb-Morley procedure is an effective and safe approach. Those patients who had complete motor deficit showed no improvement in power but those who had partial motor deficit, had excellent improvement.

Results with non-operative treatment in dorsolumbar fractures with no neurological deficit: A functional assessment

Background: The purpose of this prospective study was to assess the functional outcome of conservative treatment with early ambulation of dorso-lumbar spine fractures with no neurological deficit. Aims & Objective: The purpose of this prospective study was to identify the risk factors for dorso-lumbar spine injuries, and to assess the efficacy of non-operative treatment with early ambulation, and functional outcome of the patients. Material and Methods: From October 2008 to June 2010, 48 consecutive patients with single- level thoracolumbar spinal injury, with no neurological deficit were managed non-operatively. A custom-made thoracolumbosacral orthosis was worn by all patients for six months, and early ambulation was recommended. Patients were evaluated as per TLICS score, and if score was