Surgical Outcome of Short Segment Instrumentation including Fracture Vertebrae of Thoracolumbar Burst Fracture

Abstract

Background: Fractures of the thoracolumbar region are the most common injuries of the spine; among them burst fractures are the most frequent. Several studies were done to see the surgical outcome in thoracolumbar burst fracture hence surgery was recommended for better outcome. So, the current study was aimed to evaluate the clinical, functional and radiological outcome of short-segment pedicle screw fixation including the fractured vertebral body. Objectives: The aim of the study was to evaluate the surgical outcome of short segment pedicle screw fixation including fracture vertebrae of unstable thoracolumbar burst fracture with incomplete spinal cord injury. Methods: In this prospective observational study, a total of 62 cases were studied from May 2019 to May 2021 through non randomized purposive sampling. All the patients were between 15 to 60 years of age and operated within 21 days of fracture by posterior decompression & stabilization by short-segment pedicle screw fixation including the fractured vertebral body. Postoperative functional outcome was assessed clinically by ASIA, ODI, VAS, Denis Work Scale, Macnab criteria and radiologically by Cob’s kyphotic angle, kyphotic deformation, Beck index & Bridwell criteria. Postoperative follow up was conducted at 6^th, 12^th & 24^th weeks. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: The mean age was 31.42±11.2 years with male dominancy (74.19%). Most of the cases were manual workers (51.61%). FFH was the most common cause of injury (80.65%) and L1 was the most common level of injury (54.84%). The mean duration between injury and operation time was 14.45±3.72 days. Regarding improvement of ASIA grade, 1 grade in 46 (74.19%) cases, 2 grade in 2 (3.23%) case, no improvement in 14 (22.58%) cases were seen. Complications were hemorrhage 2(3.23%), dural tear 2(3.23%), CSF leak 2(3.23%), urinary retention 4(6.45%), skin infection 2(3.23%) and bed sore 2(3.23%). Conclusion: Thoracolumbar burst fracture with incomplete spinal cord injury can be treated with short-segment pedicle screw fixation including the fractured vertebral body effectively. This method offered a better kyphosis correction, no instrument failures, appraisable clinical and functional recovery, reduce pain and improve working status with early rehabilitation.