Management of unstable thoracolumbar spinal fractures by pedicle screws and rods fixation

The thoracolumbar junction is the most common area of injury to the axial skeleton. Forces along the long stiff kyphotic thoracic spine switch abruptly into the mobile lordotic lumbar spine at the thoracolumbar junction. Goals of treatment are to obtain a painless, balanced, stable spine with optimum neurological function and maximum spine mobility. The present prospective study has evaluated the effectiveness of pedicle screw instrumentation in various fractures around the TL spine to overcome the complications encountered in the conservative line of management of these fractures.

Thirty cases of fractures around the TL spine were operated with posterior pedicle screw fixation one or two level above and below the fracture. The cases were followed up for a mean of 9.5 months with radiological and neurological evaluation.

The average age groups of the patients studied were 21 to 53 years majority were males, fall from height being the predominant mode of injury involving the T12 and L1 vertebral body. The unstable burst fractures the most common type of fracture, radiological parameters sagittal angle and index were recorded pre and post-operatively. The neurological grading was done using the ASIA score. Follow-up was done for a minimum of 5 months where sagittal angle reduction achieved was 10.75 at final follow-up from 23.5 pre-operative. The sagittal index achieved at final follow-up was 72% compared to the pre-operative mean of 53%. The neurological improvement was regarded to be fair enough for the type of injury sustained and fixation achieved.

We found that the application of posterior instrumentation using pedicle screw and rod resulted in a reasonable correction of the deformity with a significant reduction in recumbency-associated complications; the limiting factor being the small study group and short follow-up period.