Management of fractures of thoraco lumbar spine with pedicle screw fixation
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20210498Keywords:
Pedicle screws and rod, Thoracolumbar spinal injury, Thoraco-lumbar fracturesAbstract
Background: Thoraco-lumbar fractures are serious injuries of concern, if left untreated may result in marked morbidity and disability to the patient. To study the efficacy of pedicular screw and rod fixation system (ZETA system) in achieving ‘stabilization’ in thoracic and lumbar fractures of the spine.
Methods: This was a prospective comparative on-randomized study of 20 patients who underwent pedicle screws and rod fixation in Goverment District headquarters hospital Nagapattinam with a follow-up ranging from September 2018 to December 2018 duration of 4 months. Patient selection was according to the inclusion and exclusion criteria and was surgically treated with pedicle screw and rod system (ZETA).
Results: In 75% of the patients, the fractures were reduced by using polyaxial implants and in 25% of the patients both monoaxial and polyaxial implants were used. The average regional angle during the pre-operative stage was 16.50±5.020 and 4.450±4.150 during the 1-year post-operative period. There was a significant difference between pre-op and post-operative regional angles.
Conclusions: There is a very high statistical significant restoration of vertebral body height, mean regional angle, and mean anterior wedge angle with this procedure in thoracolumbar fractures. Neurological recovery was seen significantly when all cases with neurological deficits were clubbed together.
References
Alpantaki K, Bano A, Pasku D, Mavrogenis AF, Papagelopoulos PJ, Sapkas GS, et al. Thoracolumbar burst fractures: a systematic review of management. Orthopedics. 2010;33(6):422-9.
Benson DR. Keenen TL. Evaluation and treatment of trauma to the vertebral column. J Bone Joint Surg. 1990;39:577-88.
Blick EM. Source of orthopaedics. Baltimore, Lippincott Williams and Wilkins. 1948;236-238.
Bohlmann HH, Freehafer A, Dejak J. The results of acute injuries of the upper thoracic spine with paralysis. J Bone Joint Surg. 1983;67-A:36.
Bracken MB, Collins WF, Freeman DF. Efficacy of methylprednisolone in acute spinal cord injury. J Med Assoc. 1984;251:45-52.
Bucholz, Robert W, Heckman, James D, Court-Brown, Charles M. Fractures and dislocations of the thoracolumbar spine: Rockwood and greens fractures in adults, 6th edn. Lippincott Williams and Wilkins; 2006:1548-1553.
Burney RE, Maio RF, Maynard F. Incidence, characteristics, and outcome of spinal cord injury at trauma centers in North America. Arch Surg. 1993;128(5):596-9.
Campbell SE, Philips CD, Dubovsky E. The value of CT in determining potential instability of simple wedge compression fractures of the lumbar spine. Am J Neurobiol. 1995;16:1385-92.
Daniaux H. Transpedicular reduction and spongiosaplasty for vertebral body fractures of the lower thoracic and lumbar spine. Trauma Surg. 1986;89:197-213.
El-Khoury GY, Whitten CG. Trauma to the upper thoracic spine: anatomy, biomechanics, and unique imaging features. Am J Roentgenol. 1993;160(1):95-102.
Francaviglia N, Bragazzi R, Maniello M, Bertucci C: Surgical treatment of fracture of the thoracic and lumbar spine via the transpedicular route. Br J Neurosurg. 1995;9(4):511-8.
Guttman L. Spinal cord injuries- comprehensive management and research. Oxford: Blackwell Scientific publications; 1976:137-176.
Jacobs RR, Schlaepfer F, Mathys R. A locking hook spinal rod system for the stabilization of fracture-dislocation and correction of deformities of the dorsolumbar spine; a biomechanical evaluation. Clin Orthop. 1984;189:168-77.
Chapman JR, Mirza SK, Green HR. Fractures in Adults. 5th edn. Vol. 2. Lippincott Williams and Wilkins; 2001:1295-1466.
Kelly RP. White Side TE. Treatment of lumbodorsal fracture-dislocations. Ann Surg. 1968;167:705.
Olerud S, Karlstrom G, Sjostrom L. Transpedicular fixation of thoracolumbar vertebral fractures. Clin Orthop. 1988;227:44-51.
Levanthal MR. Fractures dislocations, and fracture-dislocations of the spine. In: Canale ST, ed. Campbell’s operative orthopaedics. 9th edn. Vol. 3. Elsevier; 1998:2747-2779.
Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Ortho. 1984;189:125-41.
Martijn A, Veldluis EF. The diagnostic value of interpediculate distance assessment on plain films in thoracic and lumbar spine injuries. J trauma, 1991;31:1393-5.
Maynard FM Jr, Bracken MB, Crearey G, Ditunno JF Jr, Donovan WH, Ducke TB. International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord. 1997;35:266-74.
