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Category: Volume 07 Issue 11 November 2019
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Title: A Study on Management of Dorso-Lumbar Spinal Injuries with Posterior Instrumentation

Authors: Dr B Kiran Kumar, Dr B Viswanath Naik, Dr Naveen

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.74

Abstract

The spinal traumas are common and leading problem in orthopedic practice. The individuals are at risk of high energy trauma in the modern era and spinal trauma is commonly associated with it. Thoraco-lumbar fractures are serious injuries of concern, if left untreated may result in marked morbidity and disability to the patient.

Methods: This prospective study was undertaken in the Department of Orthopedics in MGM hospital, attached to Kakatiya Medical College, Warangal. Twenty adult patients with acute thoracolumbar injuries who gave the consent for surgery admitted during the study period were included as study sample. Patient selections were according to the inclusion and exclusion criteria and were surgically treated with pedicle screw and rod system.

Results: The most common vertebrae involved in this series were between T11 - L2 to the extent up to 75%. 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 pre operative stage was 16.50 ± 5.020 and 4.450 ± 4.150 during 1 year post operative period. There was a significant difference between pre-operative and post-operative regional angles. The advantages are restoration of vertebral body height, mean regional angle, and mean wedge angle in thoracolumbar fractures.

Conclusions: The findings of this study show that pedicle screw-rod instrumentation is the best system used in treatment of vertebral fractures. Neurological recovery was seen significantly when all cases with neurological deficits were clubbed together.

Keywords: Dorso-Lumbar Spinal Injuries, Pedicle Screw and Rod System.

References

  1. Jens R. Chapman Sohail K Mirza H. Rockwood, Green Fractures in Adults.
    Lippincott Williams and Wilkins, 5th edition; Vol. 2: 1295 - 1466.
  2. Alpantaki K, Bano A, Pasku D, Mavrogenis AF, Papagelopoulos PJ, et al. Thoracolumbar burst fractures: a systematic review of management. Orthopedics 2010;33: 422-429.
  3. Oner FC, Wood KB, Smith JS, Shaffrey CI. Therapeutic decision making in thoracolumbar spine trauma. Spine (Phila Pa 1976) 2010; 35: S235-244.
  4. Blick EM. Source of orthopedics, Baltimore, Lippincott Williams and Wilkins, 1948;236 - 238.
  5. Burney RE, Maio RF, Maynard F. Incidence, characteristics, and outcome of spinal cord injury at trauma centres in North America. Arch Surg 1993; 128(5):596-99.
  6. Riggins RS. Kraus JF. The risk of neurological damage with fractures of the vertebrae. Journal of Trauma 1977; 126-133.
  7. Benson DR. Keenen TL. Evaluation and Treatment of Trauma to the Vertebral Column. Journal of Bone and Joint Surgery 1990; 39: 577-588.
  8. Leventhal MR. Fractures, dislocations, and fracture dislocations of spine. Campbell's operative orthopedics; Edited by S. Terry Canale; 9th Edn, 1998, Vol 3:2747-2779.
  9. Guttman L: Spinal cord injuries - comprehensive management and research. Oxford: Blackwell Scientific publications: 137-176, 1976.
  10. Watson - Jones R: Fractures and Joint Injuries. Ed. J.B. Wilson, Edinburgh: Churchill Livingstone: 789-792, 1982.
  11. Robert W. Bucholz, James D. Heckman: Rockwood and Greens Fractures in adults"; Lippincott Willams and Willkins; 5th edition; Vol 2; 1293-1466, 2001.
  12. Francaviglia N, Bragazzi R, Maniello M, Berucci C. Surgical treatment of fracture of thoracic and lumbar spine via the transpedicular route. British Journal of Neurosurgery 1995; 9(4): 511-18.
  13. White AA, 3rd, Johnson RM, Panjabi MM, Southwick WO. Biomechanical analysis of clinical stability in the cervical spine.Clin Orthop Relat Res.1975;109: 85–96.
  14. Sasso RC, Cotler HB, Reuben JD: Posterior Fixation of Thoracic and Lumbar Spine Fractures using DC Plates and Pedicle Screws. Spine 1991; 16:S134-S139.
  15. Alvine GF, Swain JM, Asher MA, Burton DC. Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis: case series and literature review. J Spinal Disord Tech. 2004; 17(4):251-264.
  16. Razak M, Mahmud MM, S.A. Hyzan MY, Omar A, Short segment posterior instrumentation, reduction and fusion of unstable thoracolumbar burst fractures - a review of 26 cases, Med J Malaysia. 2000; 55 Suppl C: 9 - 13.
  17. Maximilan Reinhold, Laurent Audige, Klaus John Schnake, Carlo Bellabarba, Li Yang Dai, F Cumhur Oner. AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. Eur Spine J 2013; 22(10):2184-01.
  18. Nasser R, Yadla S, Maltenfort MG, Harrop JS, Anderson DG, Vaccaro AR, Sharan AD, Ratliff JK. J Neurosurg Spine. 2010 Aug; 13(2):144-57.
  19. Burns S, Biering-Sørensen F, Donovan W, Graves D, Jha A, Johansen M, Jones L, Krassioukov A, Kirshblum, Mulcahey MJ, Schmidt Read M, Waring W. International Standards for Neurological Classification of Spinal Cord Injury, Revised 2011. Top Spinal Cord Inj Rehabil 2012;18(1):85-99.

Corresponding Author

Dr B Viswanath Naik

Associate Professor, Dept of Orthopedics, MGM Hospital, Kakatiya Medical College, Warangal,

Telangana state, India