Outcomes with fracture-level transpedicular screws used for thoracolumbar junction fractures

Likhachev S.V., Zaretskov V.V., Arsenievich V.B., Ostrovskij V.V., Shulga A.E., Zaretskov A.V.

Abstract


Background
Short-segment transpedicular screw fixation (SSTSF) is the preferred treatment option for thoracolumbar burst fractures. Adding screws in the fractured body may be helpful in achieving and maintaining fracture reduction. However, the operative approach is disputed.
Objective
To compare clinical outcomes of transpedicular fixation with and without screws in the fractured vertebral body after isolated uncomplicated fractures at the thoracolumbar junction.
Material and methods
A retrospective cohort study enrolled 62 patients with Th11–L2 thoracolumbar burst fractures (AOSpine A3, A4) who underwent SSTSF with (n = 32) and without (n = 30) pedicle screws at the fracture level. Demographic data of the patients, operating time and blood loss were registered. Clinical evaluation using Visual analogue scale (VAS ) for pain, Oswestry Disability Index (ODI) to quantify disability and imaging parameters of segmental kyphosis, loss of correction, anterior vertebral body height (AVBH) at the fracture level, spinal canal stenosis (SCS) were measured preoperatively, at one week, 1 month, 6 and 12 months postoperatively.
Results
The patients of the two groups showed no statistically significant differences in the demographic data, VAS and ODI scores, measurements of kyphotic angle, AVBH, SCS preoperatively (p > 0.05). Screws at the fracture level did not affect the operating time and intraoperative blood loss relative to conventional no-screw group. Benefits with fracture screws were evident at 7 days (p less 0.01) measuring SCS, at 6 months (p less 0.01) and 12 (p less 0.01) months measuring kyphotic angle. There was better kyphosis correction (p less 0.01) and AVBH (p = 0.034) seen at 12 months after surgery.
Conclusion
Reinforcement of a broken vertebra with fracture-level screws has been shown to provide better stability of clinical and radiographic results as compared to those with conventional SSTSF.

Keywords


thoracolumbar junction, burst fracture, transpedicular fixation, fracture-level transpedicular screws

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DOI: http://dx.doi.org/10.18019/1028-4427-2020-26-4-548-554

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