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  • Efficacy of Short Segment Instrumentation for Thoracolumbar Burst Fractures: Viable Cost Effective Alternative?

    Final Number:
    1372

    Authors:
    Arundhati Biswas MCh MD MS FCPS; Aaron Mohanty MD; SS Praharaj

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: The treatment of thoracolumbar burst fracture is a controversial issue. Short-segment (SS) instrumentation is a less invasive and economically viable treatment option. However, there are several studies regarding the high rate of failure. The aim of this retrospective study was to evaluate the clinical and radiological factors influencing the outcome and efficacy of this procedure.

    Methods: This is a retrospective review of 57 consecutive patients who had short segment instrumentation of thoracolumbar burst fractures performed between 1997 and 2003.Baseline information following injury included demographic data and clinical characteristics regarding age, time and date of injury, mode of injury, prehospital treatment and mode of transport, interval between injury and surgery and the use of methyl prednisolone.All patients underwent a clinical and radiological assessment by an independent observer.Preoperative evaluation of neurological compromise was graded according to Frankel Grading Scale; while disability preoperatively, at discharge and at follow up was measured using the Barthel Index (BI) and Functional Independence Measure (FIM) scoring. Patients with associated head injury were excluded from the study.

    Results: Fifty seven patients were studied which included fifty three (93%) males and four (7%) females. The mean age at injury was 31.29 years (range 15-65 years).Most patients were between 15 and 25 years of age. There was significant improvement in Impairment and Disability Scores at discharge and follow up as measured by Barthel Index and Functional Independence Measure score (FIM) respectively. (p< 0.001).Frankel A showed less significant improvement compared to other groups.Mean length of stay in hospital was 35 days (range 5 -177days). Most common complication was UTI followed by wound infection.

    Conclusions: Short segment instrumentation is less invasive,more affordable and operative time less and blood replacement not necessary.Surgery affords optimal results with early mobilization. Significant improvement in functional outcome at follow up in Frankel Grades B-E.Implant failure on a long term follow up can be avoided by proper hardware selection, meticulous surgical technique towards achieving a solid bony fusion, graduated load bearing and rehabilitation.

    Patient Care: Less invasive surgical options- more economically viable with equally effective results.

    Learning Objectives: Thoraco lumbar fractures- less invasive treatment options Follow-up for treatment failure. Surgery leads to earlier mobilzation.

    References:

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