Efficacy Of Short-Segment Transpedicular Fixation for Thoracolumbar Fractures in Terms of Improvement in Neurological Status
DOI:
https://doi.org/10.36552/pjns.v28i1.948Keywords:
Keywords: Short-segment; Transpedicular fixation; Thoracolumbar fractures;Abstract
Objective: To determine the efficacy of short-segment transpedicular fixation for thoracolumbar fractures in terms of improvement in neurological status.
Materials and Methods: A prospective observational research was conducted at Bacha Khan Medical Complex, Swabi, Section of Neurosurgery. Patients having traumatic thoracolumbar fractures with neurological deficits were subjected to short-segment transpedicular fixation and evaluated for post-operative improvement in neurological status at a 6-month follow-up.
Results: 48 patients participated in the study. Mean age was 35.69±8.22 years and 60.4% were males. History of falls was the most common mechanism responsible for spinal injury i.e. 56.3%. D12 vertebra was fractured in 43.8% of patients. The leading type of fracture was, AO type B in 37.5% of patients. 23 (47.9%) of the patients showed one or more grade improvements in their neurological status on the ASIA scale at 6-month follow-up. Surgical site infection was the common postoperative complication (8.3%).
Conclusion: Short-segment transpedicular fixation is an effective procedure for traumatic thoracolumbar fractures in terms of improvement in neurological status.
References
Zhang S, Wadhwa R, Haydel J, Toms J, Johnson K, Guthikonda B. Spine and spinal cord trauma: diagnosis and management. Neurologic Clinics. 2013;31(1):183-206.
Kumar R, Lim J, Mekary RA, Rattani A, Dewan MC, Sharif SY, Osorio-Fonseca E, Park KB. Traumatic spinal injury: global epidemiology and worldwide volume. World neurosurgery. 2018;113:e345-63.
Furlan JC, Sakakibara BM, Miller WC, Krassioukov AV. Global incidence and prevalence of traumatic spinal cord injury. Canadian journal of neurological sciences. 2013;40(4):456-64.
Krueger H, Noonan VK, Trenaman LM, Joshi P, Rivers CS. The economic burden of traumatic spinal cord injury in Canada. Chronic diseases and injuries in Canada. 2013;33(3).
Merritt CH, Taylor MA, Yelton CJ, Ray SK. Economic impact of traumatic spinal cord injuries in the United States. Neuroimmunology and neuroinflammation. 2019;6:1-16.
Zhou H, Lou Y, Chen L, Kang Y, Liu L, Cai Z, Anderson DB, Wang W, Zhang C, Wang J, Ning G. Epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China: a hospital-based retrospective study. Neural Regeneration Research. 2024;19(5):1126-32.
McDaid D, Park AL, Gall A, Purcell M, Bacon M. Understanding and modelling the economic impact of spinal cord injuries in the United Kingdom. Spinal Cord. 2019;57(9):778-88.
Birua G, Munda V, Murmu N. Epidemiology of spinal injury in north East India: a retrospective study. Asian journal of neurosurgery. 2018;13(04):1084-6.
Saul D, Dresing K. Epidemiology of vertebral
fractures in pediatric and adolescent patients. Pediatric reports. 2018;10(1):7232.
Junior DL, Sá BF, POKORNY G, Almeida NS, da Silva DR, Silva JP, do Nascimento JW, Carneiro GD. Epidemiology of Thoracolumbar Fractures: A Cross-Sectional Study. 2023.
DOI: https://doi.org/10.21203/rs.3.rs-2902651/v1
Piccone L, Cipolloni V, Nasto LA, Pripp C, Tamburrelli FC, Maccauro G, Pola E. Thoracolumbar burst fractures associated with incomplete neurological deficit in patients under the age of 40: Is the posterior approach enough? Surgical treatment and results in a case series of 10 patients with a minimum follow-up of 2 years. Injury. 2020;51(2):312-6.
Ge CM, Wang YR, Jiang SD, Jiang LS. Thoracolumbar burst fractures with a neurological deficit treated with posterior decompression and interlaminar fusion. European Spine Journal. 2011;20:2195-201.
Shin SR, Lee SS, Kim JH, Jung JH, Lee SK, Lee GJ, Moon BJ, Lee JK. Thoracolumbar burst fractures in patients with neurological deficit: Anterior approach versus posterior percutaneous fixation with laminotomy. Journal of Clinical Neuroscience. 2020;75:11-8.
Tan T, Rutges J, Marion T, Gonzalvo A, Mathew J, Fitzgerald M, Dvorak M, Schroeder G, Tee J. Anterior versus posterior approach in traumatic thoracolumbar burst fractures deemed for surgical management: Systematic review and meta-analysis. Journal of Clinical Neuroscience. 2019;70:189-97.
Xu GJ, Li ZJ, Ma JX, Zhang T, Fu X, Ma XL. Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis. European Spine Journal. 2013;22:2176-83.
Wang T, Wang Z, Ji P, Zhang J, Zhang C, Zhang L. The efficacy and safety of anterior versus posterior approach for the treatment of thoracolumbar burst fractures: a systematic review and meta-analysis. Annals of Translational Medicine. 2022;10(6):1-11.
Eichholz KM, Rabb CH, Anderson PA, Arnold PM, Chi JH, Dailey AT, Dhall SS, Harrop JS, Hoh DJ, Qureshi S, Raksin PB. Congress of neurological surgeons systematic review and evidence-based guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma: timing of surgical intervention. Neurosurgery. 2019;84(1):E53-5.
Mittal S, Ifthekar S, Ahuja K, Sarkar B, Singh G, Rana A, Kandwal P. Outcomes of thoracolumbar fracture-dislocation managed by short-segment and long-segment posterior fixation: a single-center retrospective study. International Journal of Spine Surgery. 2021;15(1):55-61.
Zileli M, Sharif S, Fornari M. Incidence and epidemiology of thoracolumbar spine fractures: WFNS Spine Committee recommendations. Neurospine. 202;18(4):704.
Mak SY, Siu YC, Chau WW, Lo CY, Ma CM. Long segment versus short segment stabilization in thoracolumbar spine fracture: A retrospective clinical and radiological analysis. Journal of Orthopaedics, Trauma and Rehabilitation. 2023;30(1):22104917221128836.
El Behairy HF, M Abdelaziz A, Saleh AK, Elsherief FA, Abuomira IE, Elkawary AI, Aldahshan W, Mahmoud WS. Short?segment fixation of thoracolumbar fractures with incorporated screws at the level of fracture. Orthopaedic surgery. 2020;12(1):170-6.
Deng WX, Zhao HR, Liu H, Dong H, Ye SB, Sun H. Treatment of thoracalumbar fractures with pedicle-screw placement on the level of injured vertebrae. Zhongguo gu Shang= China Journal of Orthopaedics and Traumatology. 2011;24(7):541-3.
Li B, Sun C, Zhao C, Yao X, Zhang Y, Duan H, Hao J, Guo X, Fan B, Ning G, Feng S. Epidemiological profile of thoracolumbar fracture (TLF) over a period of 10 years in Tianjin, China. The Journal of Spinal Cord Medicine. 2019;42(2):178-83.
Charles YP, Steib JP. Management of thoracolumbar spine fractures with neurologic disorder. Orthopaedics & Traumatology: Surgery & Research. 2015;101(1):S31-40.
Razaq MN, Ali B, Khan MZ, Waqar M, Satar A, Khan MA. Rate of neurological recovery in traumatic spinal cord injuries after surgical intervention. Journal of Ayub Medical College Abbottabad. 2017;30(1):58-63.
Rehman L, Khattak A, Akbar I, Ilias M, Nasir A, Siddique M, Mushtaq M. Outcome of fixateur interne in thoracolumbar trauma. Journal of Ayub Medical College Abbottabad. 2010;22(1):49-52.
Ramírez-Villaescusa J, Hidalgo JL, Ruiz-Picazo D, Martin-Benlloch A, Torres-Lozano P, Portero-Martinez E. The impact of urgent intervention on the neurologic recovery in patients with thoracolumbar fractures. Journal of Spine Surgery. 2018;4(2):388.
Butt MF, Farooq M, Mir B, Dhar AS, Hussain A, Mumtaz M. Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation. International orthopaedics. 2007;31:259-64.
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