Short segment pedicle screw fixation of thoracolumbar fracture: a case series of 33 patients


  • Naushad Hussain Department of Orthopaedics, TNMC & BYL Nair Hospital, Agripada, Mumbai, India
  • Nirmal Dhananjay Patil Department of Orthopaedics, TNMC & BYL Nair Hospital, Agripada, Mumbai, India
  • Hiren Patel Department of Orthopaedics, TNMC & BYL Nair Hospital, Agripada, Mumbai, India
  • Akash Shakya Department of Orthopaedics, TNMC & BYL Nair Hospital, Agripada, Mumbai, India



Thoracolumbar fracture spine, Pedicle screw, Vertebral body height, Anterior wedge angle, Regional angle, Neurology


Background: Pedicle screw instrumentation in case of fracture spine provides stable fixation. However in absence of experience and proper technique of pedicle screw insertion, it is associated with many complications. We aim to study the results of patients with thoracolumbar fracture stabilized with short segment pedicle screw instrumentation.

Methods: 33 cases of thoracolumbar wedge compression fracture spine presenting to Nair Hospital were included in the study. All patients were operated by the senior author via a posterior approach and short segment pedicle screw fixation. Patients were followed up for one year.

Results: 33 patients with a mean age were 37.6 years of which 3 were females and 30 were males in our study. Fall from height (93.93%) was the most common mode of injury followed by road traffic accident (6.07%). D12 and L1 were the most common vertebrae involved. Statistically significant (p=0.01) correction in the vertebral body height occurred in the immediate postop period and there was 4.1% loss of correction at final follow-up. There was statistically significant improvements in the Regional angle (p=0.03) and anterior wedge angle (p=0.03). Residual regional angle at final follow-up was found to be >5° in 3 patients. Neurological improvement was seen in 23 (74.19%) patients (p=0.01). No improvements were seen in 8 (25.81%) patients. None of our patients had postoperative worsening of the neurological status. None of the patients had pedicle wall breach on final follow up CT scan.

Conclusions: Short segment fixation in case of wedge fracture can restore the vertebral body height, mean regional angle and mean anterior wedge angle and provide good outcome. There are poor chances of recovery of patient with Frankel grade A. Meticulous dissection and careful technique of pedicle screw insertion, adequate decompression, good contouring of the rod with correction of kyphosis can provide excellent results.


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.

Gaebler C, Maier R, Kukla C, Vecsei V. Long-term results of pedicle stabilized thoracolumbar fractures in relation to the neurological deficit. Injury. 1997;28:661-6.

Bradford DS, McBride GG. Surgical management of thoracolumbar spine fractures with incomplete neurological deficits. Clin Orthop. 1987;218:201–16.

McAfee PC, Yuan HA, Fredickson BA. The value of computed tomography in thoracolumbar fractures. J Bone Joint Surg Am. 1983;65:461–73.

Chadha M, Bahadur R. Steffee variable screw placement system in the management of unstable thoracolumbar fractures: a Third World experience. Injury. 1998;29:737–42.

Adar B, Konstatin B. Posterior instrumentation for spinal injuries and non-traumatic disorders. Report on surgical practice. East Cent Afr J Surg. 2006;11:75–80

Curtis AD, Martin AY, H T C Lu, Mark NM. Surgical treatment alternatives for fixation of unstable fractures of thoracic and lumbar spine- A metaanalysis. Spine. 1994;19(20):2266-73.

McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures: a prelimnary report. J Bone Joint Surg. 1993;75:162-7.

Panjabi MM. Biomechanical evaluation of spinal fixation devices: A conceptual framework. Spine. 1998;13:1129-34.

Scifert JL, Sairyo K, Goel VK, Grobler LJ, Grosland NM,Spratt KF, et al. Stability analysis of an enhanced load sharing posterior fixation device and its equivalent conventional device in a calf spine model. Spine. 1999;24:2206-13.

Leferint VJM, Zimmer KW, Veldhuis EFM, Ten Vergert EM, Ten Duis HJ. Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone grafts and posterior fusion in 183 patients. Eur Spine J. 2001;10(6):517-23.

Robert WG. The use of pedicle screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg. 2000;82:1458.

Hansen AY, Steven RG, Curtis AD, Steven MM. A historical cohort study of pedicle scerew fixation in thoracic, lumbar, and sacral spinal fusion. Spine. 1994;19:2279-96.

Yaser MB. Transpedicular fixation in treatment of thoracolumbar spine fractures. Ann Saudi Med. 2001;21(1-2):30-4

Martin AY. A comprehensive literature review- pedicle screw fixation devices. Spine. 1994;19(20): 2275-8.

Stephen IE, Barton LS, Vadim D. Complication associated with the technique of pedicle screw fixation- A selective survey of ABS members. Spine. 1993;18:2231-9.

Ache O, Magnus K, Henrick D, Ralph H, Inga R. Complications after transpedicular stabilization of spine. Spine. 1994;19(24):2774-9.






Original Research Articles