Pedicle screw instrumentation for unstable thoracolumbar fractures

We evaluated the results of short-segment pedicle screw instrumentation in 54 patients with unstable thoracolumbar fractures. Follow-up averaged 25 months (range, 11 to 36 months); 42 patients completed the study. Kyphosis was corrected by an average of 7 degrees at surgery and loss of correction averaged 5 degrees at the end of follow-up. On computed tomography, canal compromise averaged 57% preoperatively and 33% postoperatively. Complications included nerve root irritation due to screw penetration (1/42), screw breakage (2/42), and screw bending (6/42). Solid fusion was achieved in all cases at an average of 3 months. Of the 31 patients with normal neurologic function, 24 (77%) were pain-free at follow-up and had returned to previous levels of activity. We conclude that short-segment fixation with posterolateral fusion is effective in the treatment of unstable thoracolumbar fractures; it prevents progression of kyphotic deformity and neurologic deterioration, results in a stable fusion, and preserves uninvolved motion segments above and below the fracture site.