Results of short segment posterior fixation in AO type C fracture of dorsolumbar spine

Abstract

Introduction: Spinal traumas are common and leading problem in orthopaedics practice. The individuals are at a risk of high energy trauma in modern era. Unstable thoraco-lumbar burst fractures are serious injuries of concern, if left untreated may result in marked morbidity and disability to the patient. Thoracolumbar is the second most common segment involved in the vertebral column following cervical segment in patients with spinal injuries. Historically, the thoracolumbar fractures were treated by recumbency (bed rest for a period of 8-12 weeks). In a resource scarce country like India, the care is often neglected to the victims. So, it is the need of the hour to explore possibility of surgical stabilization, early mobilization and rehabilitation of patients. In this study, we stabilized the patients with unstable thoracolumbar burst fractures with short segment posterior instrumentation with transpedicular screws. Aim: To study efficacy of short segment posterior instrumentation in achieving stabilization of thoracic and lumbar fractures of spine. Materials and Methods: This was a prospective interventional study undertaken in the Department of Orthopedics, New Civil Hospital, Ahmedabad. 32 Adult patients with acute thoracolumbar injury admitted to Civil Hospital, AHMEDABAD were included in this study after obtaining their valid, written informed consent. Plain x-rays in anterio-posterior and lateral views were obtained and the instability of spine was confirmed using Thoraco-Lumbar Injury Classification and Severity Score. All patients underwent short segment posterior Fixation and were followed up in OPD every 4 th week after surgery till 6 months and for each follow up, neurological, radiological and clinical examinations were done to assess the spinal stability. Results and Discussion: All fractures were classified as Type C fractures according to the AO classification system. Intermediate screw was inserted in 21 patients out of 32. This study showed that fracture level screw fixation technique could achieve and maintain correction, regional angle and vertebral height. We have used the intermediate screw option in the fractured vertebra level as a method of augmentation in the current study. The results were comparable to other studies in the past. Conclusion:The findings of these study show that short segment posterior instrumentation is an excellent implant system used in the treatment of vertebral fractures. There is a very high statistically significant restoration of vertebral body height, mean regional angle and mean anterior wedge angle.