Unstable thoracolumber vertebra fracturesshort-segment pedicle fixation in treatmentresearch of its applications

Background Treatment of unstable thoracolumbar fractures remains controversial. Long-segment pedicle screw constructs may be stiffer and impart greater forces on adjacent segments compared with short-segment constructs, which may affect clinical performance and long-term out come. Thoracolumbar burst fractures with short-segment pedicle screw fixation alone may be associated with progressive loss of correction and instrumentation failure. However, some thoracolumbar fractures can be treated successfully by screwed at fracture level without correction loss or implant failure. Methods We retrospectively analyzed 38 (22 males, 16 females) unstable thoracolumbar fractures. The patients were divided to two groups. In group I, patients were operated with posterior approach using pedicle screws fixed long (two levels above and one level below the fracture vertebra). In group II patients, screwing was made at fracture level. Short segment stabilization was performed. Laminectomy or decompression procedure was done only in the cases with significant canal compression. Post operative and at follow-up in six months radiological evaluation was done by measuring the correction and maintenance of kyphotic angle at the fracture level, Cobb angle, height of fractured vertebra. Results Average follow-up was 6 months. Average preoperative kyphosis was 7.7o in group I and 13.9o in group II which was significantly different between two groups. However, average postoperative kyphosis was 8.5o and 9.6o in group I and II, respectively. There was no statitistically signficant difference. Conclusion Short segment pedicle screw fixation with screwing fractured vertebra in unstable thoracolumbar fracture level is effective method to prevent kyphosis for treatment of unstable thoraco-lumbar fractures. It provides anterior column support.