THORACOLUMBAR JUNCTION INJURIES AND THEIR MANAGEMENT WITH PEDICLE SCREWS

Authors

  • Inayatullah Khan
  • Muhammad Nadeem
  • Zia Hassan Rabbani

Abstract

Background: To evaluate the use of pedicle screw fixation in earthquake injured thoracolumbarspine. Methods: Nineteen patients with posttraumatic instability of lower thoracic or upper lumbarspine were included in the study. White and Panjabi criteriawas used to assess spinal instability. Allpatients underwent open reduction and internal fixation by posterior approach. Pedicles werelocalized using detailed anatomical landmarks and intraoperative imaging. . Local bone was used asbone graft. The neurological status of the patients and any other complications were noted up to oneyear. Results: There were 19 patients with unstable thoracolumbar junction injuries who weremanaged with pedicle screws and rods. Females were more affected (F:M ratio was 8.5:1). Wedgecompression was the commonest. None of the patients deteriorated after surgery. There were 20Frankel improvements in 18 patients (1.11 Frankel on average) with neurological deficit whereas 1patient in Frankel E remained in the same grade on subsequent follow-ups. There was one patientwith wound infection and one patient developed DVT. None of the patients developed bedsores.Conclusion: Pedicle screw fixation is a useful choice for thoracolumbar junction injuries forachieving reduction and stability in both anterior and posterior column injuries, without affectingextra motion segments.Keywords: Pedicle screws, thoracolumbar junction injuries

References

Mikles MR, Stchur RP, Graziano GP. Posterior instrumentation

for thoracolumbar fractures. J Am Acad Orthop. Surg.

;12(6):424-35.

Kirkpatrick AW, McKevitt E. Thoracolumber spinal fractures:

is there a problem? Can J Surg. 2002;45:21-4.

Yue JJ, Sossan A, Selgrath C, Deutsch LS, Wilkens K, Testaiuti

M, et al. The treatment of unstable thoracic spine fractures with

transpedicular screw instrumentation: a 3-year consecutive

series. Spine. 2002;27(24):2782-7.

Sasso RC, Renkens K, Hanson D, Reilly T, McGuire RA Jr,

Best NM. Unstable thoracolumbar burst fractures: anterior-only

versus short-segment posterior fixation. J Spinal Disord Tech.

;19(4):242-8.

Danisa OA, Shaffrey CI, Jane JA, Whitehill R, Wang GJ,Szabo

TA, et al. Surgical approaches for the correction of unstable

J Ayub Med Coll Abnbottabad;19(4)

thoracolumbar burst fractures: a retrospective analysis of

treatment outcomes. J Neurosurg 1995;83:977-83.

Shafiq K, Iqbal M, Hameed A, Mian JM. Role of transpedicular

fixation in thoracolumbar spinal injuries. Neurol Surg

;1:21-7.

Sar C, Bilen FE. Flexion was more painful than extension.

Thoracolumbar flexion-distraction injuries combined with

vertebral body fractures. Am J Orthop 2002;31:147-51.

Wesley AC, William TH. Injuries to thoracic and lumbar spine.

In: Wilkins RH, Rengachary SS, editors. Neurosurgery. 2nd ed.

New York: McGraw-Hill; 1996.p 2987-95.

Shafiq K, Ahmed M, Rehman A, Abrar S, Mian JM.

Management of unstable lower thoracic and lumbar spine with

transpedicular fixation. Ann KE Med Coll 1999;5:303-7.

Gregory JB. Lumbosacral stabilization using screw fixation

techniques. In: Wilkins RH, Rengachary SS, editors.

Neurosurgery. 2nd ed. New York: McGraw-Hill; 1996.p 3027-36.

Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS,

Ungar GH, et al. The value of postural reductions in the initial

management of closed injuries of spine with paraplegia and

tetraplegia. Paraplegia 1969;7:179-92.

White AA III, Panjabi M. The clinical biomechanics of the

spine. 2nd ed. Philadelphia: Lippincott; 1990.

Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst

fracture: short-segment pedicle fixation versus long-segment

instrumentation. J Spinal Disord Tech. 2005;18:485-8.

Denis F, Armstrong GW, Searls K, Matta L. Acute

thoracolumbar burst fractures in the absence of neurologic

deficit. A comparison between operative and nonoperative

treatment. Clin Orthop Relat Res. 1984;(189):142-9.

Willén J, Lindahl S, Nordwall A. Unstable thoracolumbar

fractures. A comparative clinical study of conservative

treatment and Harrington instrumentation. Spine.1985;

(2):111-22.

Gertzbein SD, Macmicheal D, Tile M. Harrington

instrumentation as a method of fixation in fractures of the spine.

J Bone Joint Surg Br. 1982;64:526-9.

Bradford DS, McBride GG. Surgical management of

thoracolumbar spine fractures with incomplete neurologic

deficits. Clin Orthop Relat Res 1987;218:201-16.

Esses SI, Botsford DJ, Wright T, Bednar D, Bailey S. Operative

treatment of spinal fractures with the AO internal fixator. Spine

;16(3 Suppl):S146-50.

Steffee AD, Biscup RS, Sitkowski DJ. Segmental spine plates

with pedicle screw fixation. A new internal fixation device for

disorders of the lumbar and thoracolumbar spine. Clin orthop

Relat Res. 1986;203: 45-53.

Whang PG, Vaccaro AR. Spinal Pedicle Fixation Revisited:

The Role of X-rays and Other Surgical Factors. Spine

;31(6):717-21.

White KK, Oka R, Mahar AT, Lowry A, Garfin SR. Pullout

strength of thoracic pedicle screw instrumentation: comparison

of the transpedicular and extrapedicular techniques. Spine

;31(12):E355-8.

Bransford R, Bellabarba C, Thompson JH, Henley MB, Mirza

SK, Chapman JR. The safety of fluoroscopically-assisted

thoracic pedicle screw instrumentation for spine trauma. J

Trauma 2006;60(5):1047-52.

Powers CJ, Podichetty VK, Isaacs RE. Placement of

percutaneous pedicle screws without imaging guidance.

Neurosurg Focus 2006;20(3):E3.

Zeiller SC, Lee J, Lim M, Vaccaro AR. Posterior thoracic

segmental pedicle screw instrumentation: evolving methods of

safe and effective placement. Neurol India 2005;53(4):458-65.

Yilmaz C, Atalay B, Caner H, Altinors N. Augmentation of a

Loosened Sacral Pedicle Screw With Percutaneous

Polymethylmethacrylate Injection. J Spinal Disord Tech.

;19(5):373-5.

Zou D, Yoo JU, Edwards WT, Donovan DM, Chang KW,

Bayley JC, et al. Mechanics of anatomic reduction of

thoracolumbar burst fractures. Comparison of distraction versus

distraction plus lordosis, in the anatomic reduction of the

thoracolumbar burst fracture. Spine 1993;18:195-203.

Cordista A, Conrad B, Horodyski M, Walters S, Rechtine G.

Biomechanical evaluation of pedicle screws versus pedicle and

laminar hooks in the thoracic spine. Spine J. 2006;6(4):444-9.

Lindsey C, Deviren V, Xu Z, Yeh RF, Puttlitz CM. The effects

of rod contouring on spinal construct fatigue strength. Spine

;31(15):1680-7.

Carmouche JJ, Molinari RW, Gerlinger T, Devine J, Patience T.

Effects of pilot hole preparation technique on pedicle screw

fixation in different regions of the osteoporotic thoracic and

lumbar spine. J Neurosurg Spine 2005;3(5):364-70.

Sasso RC, Cotler HB, Reuben JD. Posterior fixation of thoracic

and lumbar spine fractures using DC plates and pedicle screws.

Spine 1991;16(3 Suppl):S134-9.

Sengupta DK, Truumees E, Patel CK, Kazmierczak C, Hughes

B, Elders G, et al. Outcome of local bone versus autogenous

iliac crest bone graft in the instrumented posterolateral fusion of

the lumbar spine. Spine 2006;31(9):985-91.

Vougioukas VI, Weber J, Scheufler KM. Clinical and

radiological results after parapedicular screw fixation of the

thoracic spine. J Neurosurg Spine 2005;3(4):283-7.

Knop C, Blauth M, Bühren V, Hax PM, Kinzl L, Mutschler W.

Surgical treatment of injuries of the thoracolumbar transition. 2:

Operation and roentgenologic findings. Unfallchirurg

;103:1032-47.

White AA 3rd, Panjabi M, Thomas CL. The clinical biomechanics

of kyphotic deformities. Clin Orthop Relat Res. 1977;(128):8-17.

Olumide AD, Christopher IS, John AJ. Surgical approaches for

the correction of unstable thoracolumbar burst fractures: a

retrospective analysis of treatment outcomes. Neurosurg

;83:977-83.

Nadeem M, Ghani E, Zaidi GI, Rehman L, Noman MA, Khaliquz-Zaman. Role of fixateur interne in thoracolumbar junction

injuries. J Coll Physicians Surg Pak. 2003;13(10):584-7.

Roy-Camille R, Sailant G, Mazel C. Internal fixation of the

lumbar spine with pedicle screw plating. Clin Orthop

;203:7-17.

Thalgott JS, LaRocca H, Aebi M, Dwyer AP, Razza BE.

Reconstruction of the lumbar spine using AO DCP plate

internal fixation. Spine 1989;4:91-5.