Distal short segment fixation of thoracolumbar and lumbar injuries

Fifteen patients with thoracolumbar and lumbar spine injuries were treated between November, 1993, and April, 1996, using a posterior approach that involved short segment distal fixation at or one level below the level of injury. Medical records and radiographs were reviewed for complications, maintenance of correction, repeat surgeries and functional status. Indications for this technique included fractures and ligamentous injuries that did not require direct canal decompression and were without severe comminution. The level of injury was T12 in two patients, L1 in seven patients, L2 in two patients, L3 in three patients, and L4 in one patient. Average age at injury was 29.1 years (range 18-70). The average length of follow-up was 18 months (range 12-32). There were 11 males and four females. One patient presented with incomplete paraplegia; all others were intact to neurologic testing. Posterior instrumentation and fusion were performed in all patients with no attempt at direct decompression. Supplementary infralaminar hooks were used at the distal end in 12 of 15 patients. Mean sagittal plane correction of preoperative deformity was 7.0 degrees (range 1-24). Mean loss of correction on most recent follow-up was 4.4 degrees (range 0-11). There was one deep infection and two known cases of pseudoarthrosis. Four patients underwent hardware removal and one had loss of fixation at the superior end of the construct. No patients lost neurologic function. There were no mechanical complications at the distal end of the fixation. Three patients returned to relatively normal preinjury status, five suffered partial disability, six suffered full disability and one was lost to follow-up. From our review of this relatively small group of patients, short segment fixation distally for selected thoracolumbar and lumbar injuries appears to be a reasonable option.