Long Segment Transpedicular Screw Fixation With Decompression in Incomplete Thoracolumbar Spine Injury

Abstract

Background: Traumatic fracture of the thoracolumbar spine is one of the major causes of disability in adult population of Bangladesh. Long segment transpedicular (LST) screw fixation has gained popularity in the last decade as an effective surgical treatment. Objective: To evaluate LST screw fixation in incomplete thoracolumbar spine injury among the patients attending at National Institute of Traumatology and Orthopaedic Rehabilitation NITOR, Dhaka. Methods: This prospective follow up study was conducted in the Department of Orthopedics, NITOR, Dhaka, over a period of 2 years from January 2014 to December 2015. Incomplete thoracolumbar spinal injury patients attending at the hospital were the study population. A total of 20 patients aged 18-60 years irrespective of sex were included in the study. The patients were treated by long segment (LS) posterior instrumentation and followed periodically up to 6 months with a structured data collection sheet developed to record detail history, physical examination, investigations, operative procedure and follow-up findings of the patients. Pre and post operative patient status were measured by ASIA grading of spinal cord injury. At the end of 6 months patient's satisfaction was assessed by modified Macnab criteria. Results: A total of 20 patients, male female ratio and mean age were 5.67:1 and 33.2±11.8 years. Fifty percent cases were due to road traffic accident and the rest 50.0% were due to high energy falls. The pre-operative ASIA grade status of the patient's SCIs was B in 9 (45.0%), C in 10 (50.0%) and D in 1 (5.0%) patient. At the end of 6 month after operation, all the patients had improvement in neurological function: ASIA grade C was in 3 (15%), D was in 8 (40%) and E was in 9 (45%) of study patients. All the patients but one were satisfied about the outcomes of the (LS) posterior instrumentation. Conclusion: Long segment transpedicular screw fixation with decompression by laminectomy is an effective method of treatment of thoracolumbar spine injuries. This method enhances anatomical, clinical and functional recovery, reduce pain and improve working status with early rehabilitation.