Surgical Outcome of Thoracic and Thoraco-lumbar Injuries of the Spine: A Case For Posterior Instrumentation

Abstract

Background: Management of unstable thoracic spine fractures remains controversial. The results of treatment of injuries of the thoracic and thoraco-lumbar spine with neurological involvement have been evaluated.  Advantage of pedicle screw fixation are that neural canal dissection is not required and hence potential neural element injury by  intracanal  instrumentation avoided.

Objectives: To evaluate outcome of  pedicle screw fixation and bony fusion  for the surgical management of traumatic thoracic and lumbar spine  fractures, their respective performance and complication rates.

Study Design:

Place and Duration of Study: This study was carried out in the Department of Neurosurgery at Assir Central Hospital Abha KSA from  January 2003 to December 2004.

Materials and Methods: Twenty one patients with 32 individual vertebral injury levels (T2–L4) treated conservatively or with transpedicular spinal stabilization and bone fusion were evaluated during a 2-year consecutive period. Male: female ratio was 15:6(2.5:1)

Results: A total of 42 pedicle screws were placed from T2-L4 levels. Fracture healing and radiographic stabilization occurred at an average of 4.8 months after the initial operation. Of the patients treated conservatively, (5)35% showed significant neurological improvement compared to (6)38% of those treated surgically, but the latter group contained a much higher proportion of incomplete lesions with a far better prognosis. There were no reported cases of hardware failure, loss of reduction, or painful hardware removal.

Conclusions: These results provide evidence that with appropriate preoperative radiographic evaluation of pedicular size and orientation using computed tomography, transpedicular instrumentation is a safe and effective alternative in the treatment of unstable thoraco-lumbar  (T2–L4) spinal injuries. The place for early operation might be still further restricted.