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Category: Volume 07 Issue 11 November 2019
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Title: A study of pedicle screw fixation combined with an intermediate screw at the fracture level for treatment of thoracolumbar burst fractures without Neurological injury

Authors: Dr Ravi Chandra Yadav Madas, Dr Ameet Hanmant Kulkarni

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.178

Abstract

The main aim of the management of thoracolumbar fractures is the stabilization of fractured vertebrae which in turn promotes healing of the fractured vertebrae. The pedicle screw placed at the level of fracture is called an intermediate screw; it has been shown to improve the clinical results in managing thoracolumbar fractures.

Methods: This prospective cross-sectional study was done in the Department of Orthopedics, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. The inclusion criteria were all thoracolumbar fractures without neurological deficits, involving a fracture of the thoracolumbar spine. Exclusion criteria were Patients not under the ambit of inclusion criteria, those with medical conditions who could not undergo surgery, those not willing to participate in the study.  The patients were subjected to radiological examination by X-rays, AP and lateral view. MRI/CT scan was done to determine the instability of the spine. The patients were then subjected to pre-surgical laboratory investigations which included complete hemogram, BT & CT, FBS, LFT, and KFT. Pedicle screw placement was done as per the standard operating procedure. Postoperative antibiotics were given Thoracolumbar orthosis was used from the 4th postoperative day. Postoperative follow up was done up to 1 year.

Results: Out of the total n=25 patients n=17(68%) were male and n=8(32%) were females. The most common age group was 31 - 35 having n=8(32%) of patients. The most commonly involved level of fracture was T12 in 40% of cases followed by L1 in 36% of cases. As per AO classification, the A1 was 36% followed by A2 32 % and A3 24%. The mean preoperative VAS score was 8.5 and at the last follow up the mean VAS scores were 1.5. The most commonly encountered complication was wound infection in n=2(8%) of the patients followed by screw misplacement in n=1(4%).

Conclusion: The results of the present study shows that the intermediate pedicle screw placement has several advantages like better correction of kyphotic angle, ability to maintain the height of injured vertebrae and reduce the correction loss at follow up. The overall stress distribution pattern is favorable in the intermediate screw placement technique. Hence this technique may be considered for the treatment of unstable thoracolumbar burst fractures.

Keywords: Pedicle Screw Fixation, Intermediate Screw, Thoracolumbar Burst Fractures.

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Corresponding Author

Dr Ravi Chandra Yadav Madas

Flat No-203, Rithika Residency, Om Sai Colony, Opp Alwal Rythu Bazar, Secunderabad- 500010, Telangana state, India