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

Abstract

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 15 were 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, vertebral height 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 ventral decompression, improved and maintained vertebral alignment. (2013ESJ048)