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Short-Segment Transpedicular Screw Fixation of Unstable Traumatic Thoracolumbar Spine Fractures
| Content Provider | Semantic Scholar |
|---|---|
| Author | Seleem, Ahmed M. Farag, Alaa A. Elawady, Moataz A. |
| Copyright Year | 2014 |
| Abstract | Background: Thoracolumbar spine fractures are common in the young healthy population. The most common causes of these fractures are high-energy traumas, traffic accidents or falls from heights. Fractures can be followed by neurological deficit, which is a direct consequence of the spinal cord and/or root(s) damage. Fractures are treated with surgical or nonsurgical methods. Transpedicular screw fixation is one of the methods of surgical treatment objective: The aim of the paper was to evaluate the results of the posterior short-segment transpedicular screw fixation in the treatment of unstable traumatic fractures of the thoracolumbar spine. Patient and methods: This retrospective study included fifty patients with the diagnosis of thoracolumbar traumatic spinal fracture without posttraumatic neurologic deficit in the neurosurgical department of Banha University Hospital. They were operated upon with posterior instrumentation between January 2006 and January 2012. Results: Fifty (28 males and 22 females) with age ranging between 16 and 66 years (mean 41.8, St.D. 11.3) were operated upon by posterior transpedicular screw fixation. According to the ASIA scoring system all patients were grade E. The mean kyphotic deformities measured preoperatively was 19.2 degrees (±5.5 degrees) and at within 12 months follow-up, was 8.0 degrees (±3.6 degrees). The mean mid-sagittal diameter improved from 9.2 mm (±3.1 mm) before surgery to 15.1 mm (±0.8 mm) at the 12 months follow-up visit. Conclusion: By applying the transpedicular screw fixation of the unstable fractures of the thoracolumbar spine, a stable fracture fixation can be achieved. This kind of fixation prevents secondary spine deformities. INTRODUCTION: The thoracolumbar region is generally accepted as that part of the spine formed by vertebrae from the 11 th thoracic to the 2 nd lumbar (1) . Spine fractures, especially fractures accompanied with the spinal cord injury, pose a difficult surgical, social and economic problem (2) . The three major trauma mechanisms for thoracolumbar spine fractures are rotation/translation, distraction, and compression (3,4) . Most thoracolumbar burst fractures are stable injuries that can be treated nonsurgically (5) . Regardless of neurologic deficits, unstable burst fracture that have retropulsed bone fragments compromising the canal requires surgical interventions such as decompression of neural structures, correction of spinal deformities and stabilization. (4,6) The success of the treatment depends on the initial medical treatment, radiological diagnosis, anatomical reduction, surgical decompression of the spinal canal (if needed) and surgical stabilization (7) . In cases of neurological damage, it is necessary to determine the exact grade of mobility impairment and of sensory functions (8) . The classification and gradation of neurological damage in patients with the fractures of thoracolumbar spine are determined according to the ASIA (American Spinal Injury Association) score (3,9) . This paper presents our experiences in the surgical treatment of thoraco-lumbar fractures by transpedicular screw fixation in patients who did not have any neurological damage. PATIENTS AND METHODS: Study design: This is a retrospective study of the data of fifty patients who were hospitalized with the diagnosis of traumatic thoracolumbar spinal fracture without posttraumatic neurologic deficit in the neurosurgical department of Banha University Hospital. There were operated upon with posterior short-segment instrumentation between January 2006 and January 2012. Preoperative assessment: Patients were clinically evaluated for type of injury, extent of Neurological deficit (ASIA grade) (Table 1) (8) . AnteriorPosterior (AP) and lateral Plain Radiographs, Magnetic Resonance Imaging (MRI) and 3D-Computerized Tomography (3D-CT) scan was carried out in all patients. The segmental kyphosis angle was measured on lateral radiographs as the angle between the superior endplate of the first uninvolved vertebra proximal to the affected segment and the first uninvolved vertebra distal to the affected segment. Based on computerized tomography and magnetic resonance images of the patients, we evaluated intracanal fragments, the presence of pedicle and laminar fractures, posterior ligamentous complex status and the presence of medullary edema. Table 1: Asia Impairment Scale A = Complete: No motor or sensory function is preserved in the sacral segments S4-5. B = Incomplete: Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5. C = Incomplete: Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3. D = Incomplete: Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more. E = Normal: motor and sensory function are normal Operative technique: Our surgical procedure was attempted to reach the retropulsed bone fragments through performing both laminectomy and minimal facetectomy. In prone position, we made a midline skin incision to expose the laminae 1 or 2 levels above and below the injured levels. We performed blunt dissection until the facet joints on both sides were seen. After routine laminectomy, we removed facet joints minimally to expose nerve root of both sides. Then, beneath the dural sac, we could push the retropulsed bone fragments down into the fractured vertebral body to their rightful position in the burst vertebral body. The manipulation was ought to be performed with great care to avoid damage to the neural structures. This was a crucial procedure to decompress the neural canal without removal of the retropulsed bone fragments. After the posterior decompression and bone fragment repositioning, the transverse processes, laminae of above and below level, and other posterior bony surfaces were decorticated for posterolateral fusion. Then, we carried out the classical short-segment pedicle screw instrumentation (transpedicular screw and rod instruments). Finally, we embedded sufficient amount of harvested bone fragments and artificial bone chips in the posterolateral sides of the column (posterolateral fusion) Follow up: The outcome was evaluated with (ASIA) (8) scale after three months, six months and one year following surgery. Plain x-Ray both anteroposterior and lateral views and 3D Computed Tomography were done postoperatively. The segmental kyphosis angle and the extent of collapse were measured on lateral radiographs at each visit. The presence of fusion was determined from two plain radiographs and was verified |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://www.bu.edu.eg/portal/uploads/Medicine/NEUROSURGERY/439/publications/Alaa%20Abd%20El-Moaty%20Farag_Short-Segment%20Transpedicular%20Screw%20Fixation%20of%20Unstable%20Traumatic%20Thoracolumbar%20Spine%20Fractures.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
