Clinical and radialogic effects of laminectomy during posterior pedicle screw fixation in the surgical management of thoracolumbar fractures

Background: In the studies carried out to date, it has been concluded that laminectomy application deteriorates the spinal alignment, causes an increase in kyphosis and creates instability due to the decrease in the strength of the lumbar motion segment in patients who have undergone laminectomy but not pedicle fixation. For this reason, there are reservations that the application of laminectomy in addition to posterior pedicle screw fixation in the treatment of thoracolumbar junction fractures may adversely affect spinal repair and cause fusion failure. Although these reservations about laminectomy persist, there is no study in the literature on the effect of laminectomy in addition to posterior pedicle screw fixation in thoracolumbar fractures on spine alignment, vertebral corpus anterior posterior length, anterior and posterior corpus height, spinal canal diameter and free bone fragment resorption. The aim of this study is to retrospectively evaluate the effects of adding laminectomy to the treatment on corpus anterior posterior diameter, spinal canal diameter, corpus anterior posterior height and neurological status in patients who admitted to our service due to unstable thoracolumbar spine fracture and who underwent posterior pedicle fixation. Methods: In this study, the information of patients who were operated for unstable thoracolumbar fracture in the Department of Neurosurgery of Recep Tayyip Erdoğan University Training and Research Hospital between August 2017 and July 2022 was obtained retrospectively. The patients divided into two groups according to surgery procedure. The patients who underwent posterior transpedicular screw fixation without laminectomy were classified group1. The patients who underwent posterior transpedicular screw fixation with laminectomy were classified group 2. The patients who has osteoporosis and older than 70 years old were excluded from reseach. Results: We retrospectively analyzed 43 patients. The patients who underwent posterior transpedicular screw fixation without laminectomy were classified group 1 (31 patients, %72.1). The patients who underwent posterior transpedicular screw fixation with laminectomy were classified group 2 (12 patients, %27.9). There was a statistically significant differance between the two groups in the preoperative anterior posterior diamater of spinal canal (APDSC) (U= 90.000, Z=-2.614, P=0.009), but there was no xii differance between the two groups in terms of postoperative SCAPD (U= 134.500, Z=-1.422, P=0.155). There was no differance between the two groups in terms of preoperative the ratio of anterior and posterior vertebral heights (AP ratio) (U= 130.500, Z=-1.505, P=0.132), but there was a statistically significant differance between the two groups in the postoperative AP ratio (U= 93.000, Z=-2.522, P=0.012). Conclusions: In our study, effective results were obtained in terms of both neurological recovery and preservation of appropriate thoracolumbar alignment in patients who underwent laminectomy in addition to posterior pedicle screw fixation due to thoracolumbar spine fracture. There was no significant difference between the patients in group 1 and group 2 in terms of maintaining the spine height and providing alignment, and more successful results were obtained in group 2 patients compared to group 1 in terms of clinical improvement. Keywords: Thoracolumbar fracture, posterior pedicle screw placement, laminectomy