Early Experience with Percutaneous Transpedicular Screw Fixation for Thoracolumbar Fractures at a Tertiary Hospital in Pakistan.

  • Usman Ahmad Kamboh Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore
  • Mehreen Mehboob Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore
  • Mohammad Ashraf University of Glasgow, Wolfson School of Medicine
  • Saman Shahid Department of Sciences & Humanities, National University of Computer & Emerging Sciences
  • Kashif Ali Sultan Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore
  • Muhammad Asif Raza Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore
  • Syed Shahzad Hussain Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore
  • Naveed Ashraf Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore
Keywords: Minimally Invasive Spinal, ercutaneous Transpedicular Screw, Thoracolumbar fractures, Functional Outcomes, AO Fracture, Thoracolumbar Injury Classification and Severity

Abstract

Objective:  To present our early experience with percutaneous transpedicular screw fixation for thoracolumbar fractures at a tertiary care hospital in Pakistan.

Material & Methods:  A case series of 20 patients with thoracolumbar fractures, who met the inclusion and exclusion criteria were followed for up to six months to evaluate their functional status using the Oswestry Disability Index (ODI). Kendall’s tau, Spearman’s rho and Pearson correlations were conducted to draw useful conclusions.

Results:  85% patients’ injury was reported from ‘fall from height’. 55% of the fracture was the dorsal-lumbar junction (T12-L1). Burst type morphology was reported in maximum number of patients (65%). 55% of patients were reported to be neurologically intact. ODI score’s mean percentage decreased from 40% to 23% during the first week to six months, indicates an improvement in the disabilities. A significant (p<0.050) positive correlation was found between fracture morphology and ODI. All patients had an accurate screw trajectory postoperatively and no postoperative complications were documented. Neurology was stable for all patients at 1, 3 and 6 months.

Conclusion:  Percutaneous transpedicular screw fixation can be a viable approach for thoracolumbar burst fractures with intact posterior ligamentous complex in all types of thoracolumbar fractures, including type C and leads to an improvement the quality of life. Fracture morphology has a significantly positive correlation with a higher disability index score, with more severe fracture morphologies as per the Thoracolumbar Injury Classification and Severity (TLICS) score having a higher disability.

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Published
2021-06-14
Section
Original Articles