Background: The thoracolumbar spine is vulnerable to fracture in falls or motor vehicle accidents. Thoracolumbar
spine fracture can be associated with neurological deficits, long-term pain and disability. The optimal management
for these injuries remains a considerable subject for research.
Objectives: To evaluate short-term surgical and functional outcome of posterior short-segment fixation with
implanting pedicle screw in the fractured level (short same-segment fixation) for treatment of recent single-level
traumatic thoracolumbar fracture.
Methods: This prospective study included 36 patients with radiologically confirmed single-level thoracolumbar
fracture. Patients were evaluated preoperatively, at time of discharge, and at follow-up visit after 1 year clinically
using the Low-Back Outcome Scale of Greenough and Fraser Score, the American Spinal Injury Association (ASIA)
for neurological evaluation, and the AO fracture classification for injury severity evaluation. Radiological evaluation
included calculation of the sagittal index (SI) of injured vertebral body, anterior body compression (ABC) according
to Mumford’s equation, and regional kyphosis using Cobb angle. All patients underwent posterior trans-pedicular
screw insertions into a vertebral body one level above and below the fracture site, and an additional pedicle screw
was inserted at the level of the fracture. Postoperative clinical and radiological evaluations were compared to the
preoperative.
Results: All surgeries were conducted uneventfully within 129.7 ± 33.9 min with mean operative blood loss of 351.4
± 140.5 ml. Wound infection was encountered in two patients and responded to conservative treatment. Mean duration
of postoperative hospital stay and follow-up were 17.7 ± 4.4 days and 26.5 ± 5.1 months, respectively. After 1 year, mean
low-back pain scores were significantly higher than preoperative and early postoperative scores and frequency of patients
with excellent-good postoperative status was significantly higher at early postoperative evaluation and after
1 year compared to the preoperative status. Eight patients had neurological deficit, after 1-year follow-up; six
patients were improved by one grade, while the other two cases remained stationary. Mean SI and ABC calculated at
discharge and after 1 year were significantly higher compared to the preoperative measures. Mean Cobb angle was
significantly decreased compared to the preoperative angle. Mean improvement of kyphosis angle at discharge and
after 1 year was 60.9% and 48.1%, respectively; however, there was loss of kyphosis correction by about 4.2° after 1-year
follow-up compared to the early postoperative finding. |
