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 Mcnab’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-Whitney’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 12.44±9.6 days in Group A and 8.6±2.7 days in Group B (p=0.1273). Intraoperative blood loss was 468±94.6 mL in Group A and 693±88.3 mL in Group B (p<0.001). The mean surgical time in Group B cases (149.33±4.72 minutes) was more than those in Group A (110.8±4.65 minutes) (p<0.001). The average duration of hospital stay was 27.8±7.33 days in Group A and 24.3±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 Mcnab’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.