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Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 49-55

Posterior instrumented stabilization in the management of unstable thoracolumbar spine fractures with minimum 2 years follow-up

1 Department of Orthopaedics, PD Hinduja National Hospital & MRC, Mahim, Mumbai, Maharashtra, India
2 Department of Orthopaedics, Jawaharlal Nehru Institute of Medical Sciences, Imphal East, Manipur, India
3 District Hospital, Ukhrul, Manipur, India

Correspondence Address:
Dr. Pramod Nittur Kumaraswamy
Department of Orthopaedics, PD Hinduja National Hospital & MRC, Mahim, Mumbai 400016, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JOASP.JOASP_19_22

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BACKGROUND: Thoracolumbar region (T11–L2) involvement is most common among the spinal injuries often associated with catastrophic neurodeficits. There are many classification systems to describe thoracolumbar fractures, but few have been useful in recommending surgical decision. The treatment of thoracolumbar fracture has been debated extensively. Optimal surgical approach to be used to treat thoracolumbar fractures remains controversial. MATERIALS AND METHODS: Thirty-four patients with thoracolumbar injury classification and severity score ≥5, who underwent posterior instrumentation, were studied prospectively between August 2018 and July 2021. Follow-up assessment was done using x-ray, American Spinal Injury Association (ASIA) impairment scale, Denis pain and work scale, and Oswestry disability index. RESULTS: Most of the patients were belonged to age group 31–40 years (44.1%, n = 15); L1 was the most common vertebra injured (61.8%, n = 21). Average kyphosis correction obtained by surgery was 10.53°, and the average loss of kyphosis correction at 2 years was 2.94°. Surgery duration and blood loss when compared between short-segment fixation (SSF) and long-segment fixation (LSF) showed a statistical significance (P < 0.0001). Associated injuries were seen in 11.76% (n = 4) of patients. At final follow-up, 85.71% (n = 24) of patients showed improvement to one higher ASIA grade; 82.4% (n = 28) of patients reported to have no pain or occasional minimal pain. CONCLUSIONS: Posterior pedicle screw-rod fixation is relatively safe, more familiar, and associated with less morbidity. Most of the fractures can be treated by SSF, but in patients with severe vertebral body comminution (AOtype A3) and AO type C fractures, LSF can be done.

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