Comparison of Posterior Short-segment Pedicle Screw Fixation with or without Fusion in Thoracolumbar Burst Fractures RC01-RC04
Dr. Gaurav Mahesh Sharma,
F5, New Mahavirjyot Appartments, Govardhan Nagar, LBS Marg, Mulund, West Mumbai-400080, Maharashtra, India.
Introduction: Treatment of unstable Thoracolumbar vertebra burst fractures has seen a paradigm shift from conservative to surgical modalities with either a short or long-segment posterior fixation with or without fusion.
Aim: To assess the functional and radiological outcome in burst fractures of thoracolumbar vertebrae treated with short-segment posterior instrumentation with and without fusion.
Materials and Methods: The study was conducted on 31 patients, divided into two groups, with thoracolumbar burst fractures. Patients above18 years of age, with or without neurological deficit, Kyphosis>300, anterior vertebral height loss >50%, spinal canal narrowing >40% were included in the study. Group A (n=15) had patients in which posterior short-segment pedicle screw fixation was done while patients with pedicle screw fixation combined with posterolateral fusion were in Group B (n=16). The final outcome was measured using the Modified Mcnabâ€™s questionnaire, low back outcome scale of Greenough and Fraser and Frankel scoring system at an interval of 3,6 and 12 months were calculated using the Mann-Whitneyâ€™s U-test which was not statistically significant (p=0.770).
Results: The most common mode of injury was road traffic accident affecting 23 (74.2%) cases. L1, L2 and T12 were the most commonly involved vertebrae. The time duration between the injury and surgery was 12.44Â±9.6 days in Group A and 8.6Â±2.7 days in Group B (p=0.1273). Intraoperative blood loss was 468Â±94.6 mL in Group A and 693Â±88.3 mL in Group B (p<0.001). The mean surgical time in Group B cases (149.33Â±4.72 minutes) was more than those in Group A (110.8Â±4.65 minutes) (p<0.001). The average duration of hospital stay was 27.8Â±7.33 days in Group A and 24.3Â±8 days in Group B (p=0.3056). There was a gradual improvement in Frankel scoring, anterior vertebral height and kyphotic angle at last follow-up. The Greenough low back outcome score was 45.25 in Group A and 46.10 in Group B cases which were not significant. As per the modified Mcnabâ€™s questionnaire, 17 (54.83%) had excellent, 10 (32.2%) had good and 4 (12.9%) had the poor functional outcome. Superficial infection and screw loosening were apparent in 3 (9.6%) cases.
Conclusion: Posterolateral fusion combined with fixation is not superior to fixation alone in burst thoracolumbar fractures.