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  • Short Segment Posterior Fixation with Index Level Screws Versus Long Segment Posterior Fixation for Thoracolumbar Spine Fracture: Angle of Correction and Pain

    Final Number:

    Ahmed Mamdouh Sallam MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: As a simple and commonly used technique, short-segment pedicle instrumentation of thoracolumbar instability seems to have a high rate of implant failure and recurrence of instability.Data obtained from those studies suggest that the use of transpedicular screws at the fractured level provides the advantages of a stiffer construct, an increased biomechanical stability and the effect of 3-point fixation of the unstable segment leads to gardening against pulled-out.

    Methods: Methods: A prospective study of 61 patients, have single level thoracolumbar spine fracture with Cobb's angle = 25°, underwent posterior fixation. Of them, Thirty three patients underwent short segment fixation one level above and one level below with screws into the index level, and twenty eight patients underwent long segment fixation with two levels above and two levels below with skipped index level. All patients were followed up for about 1 year until the fusion achieved. The angle of correction and pain were regularly assessed by Cobb's angle measurement and visual analogue scale (VAS) respectively.

    Results: The sixty one patients who underwent posterior fixation was grouped into 33 short segment cases and 28 long segment cases. the post –operative mean angle of correction were 6.8° ± 2.6° and 5.8° ± 1.6° respectively (P= 0.098). After 1 year follow up, the angle of correction have become 7.8° ± 1.6° and 7.9° ± 1.8° respectively (P= 0.860). The pain was assessed by VAS on regular base follow up. In short segment group the pre-operative VAS was 5.6 ± 2.1 whereas the long segment group VAS was 5.1 ± 2.1 (P= 0.284).On one year follow up the VAS were 1.4 ± 0.5 and 1.8 ± 0.4 (P= 0.590) respectively.

    Conclusions: Conclusion: the short segment fixation with screws into index level can maintain the angle of correction till the fusion achieved as long segment fixation

    Patient Care: Short segment fixation for thoraco lumbar fractures will decrease blood loss, minimize tissue destruction,rapid relief of pain than long segment fixation and can maintain the same biomechanical stability

    Learning Objectives: Objective: The purpose of this study was to assess and compare between short segment fixation with screws into index level (fractured level) versus long segment posterior fixation in maintaining angle of correction and post-operative pain

    References: 1. Patel, A.A. and A.R. Vaccaro, Thoracolumbar spine trauma classification. J Am Acad Orthop Surg, 2010. 18(2): p. 63-71. 2. Vaccaro, A.R., et al., The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech, 2005. 18(3): p. 209-15. 3. Toyone, T., T. Tanaka, and D. Kato, The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation: a prospective study. Spine (Phila Pa 1976), 2006. 31(7): p. E208-14. 4. Anekstein, Y., T. Brosh, and Y. Mirovsky, Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures: a biomechanical study. J Spinal Disord Tech, 2007. 20(1): p. 72-7. 5. Yu, S.W., K.F. Fang, and I.C. Tseng, Surgical outcomes of short-segment fixation for thoracolumbar fracture dislocation. Neurosurg Focus, 2010. 25(4): p. 253-9. 6. Lewkonia, P., E.O. Paolucci, and K. Thomas, Reliability of the thoracolumbar injury classification and severity score and comparison with the denis classification for injury to the thoracic and lumbar spine. Spine (Phila Pa 1976), 2012. 37(26): p. 2161-7. 7. Yang, M., G.Z. Ding, and Z.J. Xu, Surgical Outcome in Thoracolumbar Fractures Managed by Short-segment Pedicle Instrumentation. Ann Acad Med Singapore, 2014. 43(1): p. 24-32. 8. Korovessis, P., T. Repantis, and P. George, Treatment of acute thoracolumbar burst fractures with kyphoplasty and short pedicle screw fixation: Transpedicular intracorporeal grafting with calcium phosphate: A prospective study. Indian J Orthop, 2007. 41(4): p. 354-61. 9. Fradet, L., et al., Biomechanics of thoracolumbar junction vertebral fractures from various kinematic conditions. Med Biol Eng Comput, 2014. 52(1): p. 87-94. 10. Eno, J.J., J.L. Chen, and M.M. Mitsunaga, Short same-segment fixation of thoracolumbar burst fractures. Hawaii J Med Public Health, 2012. 71(1): p. 19-22. 11. Kim, H.S., et al., Short segment fixation for thoracolumbar burst fracture accompanying osteopenia : a comparative study. J Korean Neurosurg Soc, 2013. 53(1): p. 26-30. 12. Baaj, A.A., et al., Biomechanical advantage of the index-level pedicle screw in unstable thoracolumbar junction fractures. J Neurosurg Spine, 2011. 14(2): p. 192-7. 13. Watts, A., et al., A biomechanical comparison of short segment long bone fracture fixation techniques: single large fragment plate versus 2 small fragment plates. J Orthop Trauma, 2012. 26(9): p. 528-32. 14. Mahar, A., et al., Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007. 32(14): p. 1503-7. 15. Ilharreborde, B., et al., Circumferential fusion with anterior strut grafting and short-segment multipoint posterior fixation for burst fractures in skeletally immature patients: a preliminary report. J Pediatr Orthop, 2012. 32(5): p. 440-4.

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