Outcome of Pedicle Screw Fixation and Monosegmental Fusion in Patients with Fresh Thoracolumbar Fractures

Asian Spine Journal, 2014 · DOI: 10.4184/asj.2014.8.3.298 · Published: June 1, 2014

Spinal Cord Injury Surgery Musculoskeletal Medicine

Simple Explanation

This study evaluates the effectiveness of using pedicle screw fixation and monosegmental fusion to treat fresh thoracolumbar fractures. The goals are to restore spinal stability, decompress the spinal canal, and enable early patient mobilization. The research involved 66 patients with thoracolumbar fractures who underwent surgical stabilization using pedicle screws and monosegmental fusion. The study assessed clinical, radiological, and functional outcomes. The study found that this surgical method is safe and effective for managing fresh thoracolumbar fractures, helping to prevent postoperative loss of correction. However, the degree of radiographic correction does not directly correlate with functional outcome or quality of life after spinal cord injury.

Study Duration

April 2007 and March 2011

Participants

66 patients (46 males and 20 females) with thoracolumbar fractures and neurological deficit

Evidence Level

Prospective clinical study

Key Findings

1
Significant improvements were observed in sagittal index and compression percentage postoperatively, with these improvements largely maintained at the one-year follow-up.
2
Neurological status improved by an average of 1.03 grades on the ASIA Impairment Scale from preoperative assessment to the one-year follow-up.
3
Early surgery (within 7 days of injury) showed a trend towards greater neurological, radiological, and functional improvements compared to late surgery, although this difference was not statistically significant.

Research Summary

The study evaluated the clinical, radiological, and functional outcomes of patients with fresh thoracolumbar fractures treated with pedicle screw fixation and monosegmental fusion. The results indicated significant improvements in radiological parameters such as sagittal index and compression percentage, as well as neurological status, following surgical intervention. Posterior surgical instrumentation using pedicle screws with posterolateral fusion is a safe and effective method for managing fresh thoracolumbar fractures, but radiographic corrections do not directly correlate with functional outcome and quality of life post-SCI.

Practical Implications

Surgical Technique

Posterior instrumentation with pedicle screws and posterolateral fusion is a reliable surgical option for thoracolumbar fractures.

Timing of Surgery

Early surgical intervention may lead to better outcomes, although significant improvements can still be achieved with delayed surgery.

Patient Expectations

Radiological correction does not guarantee improved functional outcomes or quality of life, emphasizing the importance of managing patient expectations.

Study Limitations

1
The study included a limited number of cases with 3 or 4 level fixations, preventing comparison with 2 level fixations.
2
The patient population consisted primarily of individuals with neurological deficits, limiting the ability to evaluate differences between neurologically intact and deficit patients.
3
The study lacked emergency stabilization facilities, potentially impacting the timing of surgical intervention and subsequent outcomes.

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