Comparative study between short segment fixation with and without pedicle screw at the fracture level for thorocolumbar fracture
Abstract
The most common fractures of the spine occur in the thoracic (mid back) and lumbar spine (lower back) or at the junction of the two (thoracolumbar junction). These fractures are managed surgically. This study was conducted on 50 thoracolumber fracture cases to find out better management modality among open short segment injury level pedicle screw fixation and conventional open short segment pedicle screw fixation. Inference was made with un paried’t’ test and chi square test. It was observed that average Surgical blood loss and post op drain in open short segment injury level pedicle screw fixation and conventional open short segment pedicle screw fixation is almost similar with insignificant difference (p>0.05) only and average surgical time was significantly more in open short segment injury level pedicle screw fixation and conventional. It was observed that the results of open short segment injury level pedicle screw fixation shows significantly better correction of saggital cobb’s angle (p<0.001). There was no significant difference in other corrections like fractured vertebral body (°) angle, anterior vertebral body height and Posterior vertebral body height. Final outcome after one year follow up as per Modified MacNab criteria was without significant difference in both the groups. In patients treated with open short segment Injury level pedicle screw fixation had developed more infection rate (16%) but lesser or no Hardware failure (0%) in compare to conventional short segment pedicle screw fixation where infection rate is (12%) and hardware failure problem (12%). Hardware failure was significantly less in open short segment Injury level pedicle screw fixation than conventional one. So it can be concluded that open short segment injury level pedicle screw fixation is better than conventional open short segment pedicle screw fixation.
Keywords
Download Options
Introduction
Spinal fracture is a serious injury. The most common fractures of the spine occur in the thoracic (mid back) and lumbar spine (lower back) or at the junction of the two (thoracolumbar junction). These fractures are typically caused by high-velocity accidents, such as a car crash or fall from height.
The primary treatment of thoracolumbar injures is surgical reduction, decompression and stabilization. Advantage of an operative procedure for treating these injuries is the immediate stabilization of injured spine and an indirect or direct decompression of neural structure. Operative stabilization enables early mobilization without heavy and uncomfortable cast and shortens the hospital stay.
Metallic internal fixation device were first introduced in 1956 Harrington Fusion system introduce laminar hooks and rod for rigid spine fusion but hooks could pullout and cause loss of correction.1
Conclusion
This present study conclude that the results of open short segment injury level pedicle screw fixation shows significantly better correction of saggital cobb’s angle (p<0.001). There was no significant difference in other corrections like Fractured vertebral body (°) angle, Anterior vertebral body height and Posterior vertebral body height. Final outcome after one year follow up was without significant difference in both the groups. Hardware failure was significantly less in open short segment Injury level pedicle screw fixation than conventional one. So it can be concluded that open short segment injury level pedicle screw fixation is better than conventional open short segment pedicle screw fixation.