OUTCOME OF LONG SEGMENT TRANSPEDICULAR STABILIZATION FOR THE MANAGEMENT OF THORACOLUMBAR FRACTURE

Yousuf Ali*, Chowdhury Iqbal Mahmud, Shahida Akter, Khandaker Md. Nurul Arifeen, Ali Faisal, A. Z. M. Salimulla, Samrat Parajuli and Sachindra Joshi

ABSTRACT

Background: Thoracolumbar junction is the common area for spinal column fracture following a high energy trauma, of which most are burst fracture. Neurological deficit following the thoracolumbar fractures has resulted in increased morbidity in young patients. The posterior long segment transpedicular stabilization has gained popularity for its rigid fixation, improved radiological parameters and lesser failure rates; and has enhanced the patients’ rehabilitation. Aim: This study was conducted to evaluate the outcome following long segment transpedicular stabilization for the management of thoracolumbar fracture. Methods: This multicentric prospective experimental observational study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU) and different private clinics of Dhaka, Bangladesh from July 2006 to June 2020. Total no of patients was 205, only those patient treated with posterior decompression stabilization by posterior long Segment fixation and posterolateral fusion were included in this study. Multiple variables were studied, including demographic data, clinical variables, and radiological variables. Patients were followed up for at least one year. Outcomes were measured by VAS score, ASIA grading and radiological parameters. Results: In analyzing VAS scores of the participants in different stages of treatment, the score was improved from 6.90±1.16 (Mean ± SD) in pre-operative stage to 2.0±0.8 (p value <0.001) in final follow up. Based on ASIA Grading majority of the patients had ‘B’ to ‘C’ scores. At immediate postoperative period most of the patients had improved by one grade. But at the end of one year follow- up, majority of the patients (n=195) achieved ‘E’ score which was found in 95%. The mean preoperative angle of injured vertebra was 18.5°, the mean postoperative angle was 8.8°, the mean angle at 6 month’s follow-up was 10.5°, the mean initial correction was 9.9°, and the mean loss of correction was 1.9°. So, the mean overall correction was found 8.0°. In analyzing the average percentages of the anterior body compression, it was 55.5% in preoperative stage and improved to 35% postoperatively, but slightly declined to 32.7% at the latest follow-up. Conclusion: The management of thoracolumbar fracture by long segment transpedicular stabilization provides an optimal clinical and neurological improvement with improved radiological parameters and lesser degree of complications in long term follow-up.

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