Study Design: Retrospective matched cohort study. Objectives: Identifying candidates for isolated percutaneous screw fixation (PSF) in thoracolumbar fractures based on Thoracolumbar Injury Classification and Severity (TLICS) score. Methods: Patients underwent PSF were split into 3 TLICS-score categories, then matched with groups having similar scores managed either non-operatively or via open screw fixation (OSF). Each category was assessed for corrective power and loss of correction by comparing initial and 1-year Cobb angles as well as Oswestry Disability Index and rates of fracture healing at 1 year. Results: A total of 102 patients (40 females) with age range 19 to 51 years, were admitted 1 to 25 hours following trauma. Each of TLISC categories consisted of matched treatment groups for comparison. In TLICS-3 fractures (2 treatment groups, n = 12 each), PSF showed similar outcomes but longer time to ambulation and length of stay (LOS) compared with nonoperative management. In TLICS-4 fractures (3 treatment groups, n = 18 each), PSF showed comparable corrective power and outcomes as OSF but was better in terms of operative time, blood loss, time to ambulation, LOS, and cosmesis. Despite higher LOS when compared with nonoperative cases, PSF showed superior radiologic and functional outcomes. In TLICS-5 fractures (2 treatment groups, n = 12 each), PSF showed shorter admissions and time to ambulation but lower corrective power, functional recovery, and tendency to lower healing rates. Conclusions: Isolated PSF is a valid choice in managing TLICS-4 thoracolumbar fractures; however, it did not surpass conventional methods in TLICS-3 or TLICS-5 fracture types. Further studies are needed before the generalization of findings.

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Background: Each year, there are approximately 5 million new vertebral fractures worldwide. Being a mobile flexible segment that is prone to severe stresses and loads, thoracolumbar fractures are considered one of the most controversial and challenging fracture types to manage. Objective: The aim of this study is to explore the technique and to evaluate feasibility, safety, and outcome of percutaneous transpedicular fixation in the management of thoracolumbar fractures. Methods: This study was carried out in the period between May 2016 and June 2017, where 20 consecutive patients with thoracolumbar fractures, based on TLICS scoring and neurological status, underwent a posterior percutaneous transpedicular fixation. The mean age was 33.85 years, range 20-49 years. Patients were followed up for 12 months. Patients had their clinical outcomes reviewed and evaluated in terms of cosmesis by visual analog scale (VAS) and in terms of Cobb angle correction. Results: The length of the procedure varied from 120 to 180 min with mean time of 154.50 min. There was no significant blood loss in all cases. The volume of blood loss ranged from 150 to 200 cc with mean loss of 174.25 cc. No major intraoperative complications happened in our study cases. Six cases had only one laterally malpositioned screw each. All cases returned to their previous activity without limitations (E5). Those who were completely pain free (F5) were 15 patients. Only five patients were suffering from moderate pain (F4). The Prolo scale was either 9 or 10 with mean of 9.60. Conclusion: By comparing our results with other studies, we found more or less equivalence in terms of neurological recovery, functional outcome, fusion rate, and maintenance of correction gain. However, the cosmesis scores for patients in the study were great.

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Background Data: Result of redo discectomies varies widely in the literature. This may be due to variability in inclusion criteria and associated pathologies which may alter results. We tried to evaluate the early outcome of recurrent sciatica after redo discectomies in highly selected cases and risk factors for poor outcome. Purpose: to assess the rate of success of redo lumbar discectomy in patients with recurrent sciatica. Study Design: A retrospective clinical case study Patients and Methods: A retrospective study including 30 cases with recurrent sciatica caused by true recurrent disc herniation over a period of 8 years. Clinical and radiological data were analyzed for proper selection and to exclude cases with associated pathologies. A Visual Analogue Scale was used to score pain severity before and after surgeries. Complications following redo surgeries were classified as minor and major. The outcome depended on pain relief and complications. Probable risk factors were recorded to detect those that might have contributed for unsatisfactory results. Results: Outcome was satisfactory in 20 cases, accepted in 6 cases and unsatisfactory in 4 cases. The overall improvement in sciatic pain after redo surgeries was comparable with that following primary surgery. We found diabetes the major risk factor for unsatisfactory results. Conclusion: Redo discectomy for recurrent sciatica proved to be of value and high rate of success when attempted in well-selected cases. (2014ESJ065)