Comparative Study of Short Segment Pedicle Screw Fixation with or without Intermediate Screw in the Treatment of Unstable Thoracolumber Fracture

Résumé

Background: Unstable thoracolumber fracture needs surgical stabilization. For many years short segment and long segment stabilization procedure were used. Short segment fixation including fracture vertebra is a technique of fixation. Objectives: To compare the outcome of short segment posterior fixation with incorporating fractured vertebra and short segment posterior fixation without incorporating fractured vertebra in the treatment of thoracolumber fracture. Methods & Materials: This prospective comparative observational study was carried out in the Orthopedic Surgery department of M.A.G. Osmani Medical College Hospital, Sylhet, during March 2019 to August 2021 including 23 patients of unstable thoracolumber fracture in group A(PFFV) and 23 patients in group B(SSPF). Assessment of Neurological outcome was done by ASIA impairment scale, functional outcome by Oswestry disability index, visual analogue score, modified Mcnab criteria,and radiological outcome by pre- and post-operative cobb kyphotic angle measurement. Statistical analyses were done by SPSS-22. Results: Most commonly involved level was at L1 (52.17%). In case of ASIA impairment, Scale 1 grade improvement in 16(69.6%) patients in PFFV group and 15(65.2%) patients in SSPF group, Scale 2 grade improvement in 7(30.4%) patients in PFFV group and 7(30.4%) patients in SSPF group. Functional outcome were improved in postoperative successive follow up. There was no significant difference in the neurological and functional outcomes between two groups (P>.05). The mean preoperative cobb’s kyphotic angle was 22.26±7.56 in PFFV group and 22.30±4.74 in SSPF group. Immediate post operative cobb’s kyphotic angle was 5.22±2.71 in PFFV group and 5.48±1.75 in SSPF group. The pre- and postoperative difference between 2 groups was not statistically significant.. In the last follow up at 6 months cobb’s kyphotic angle was 8.96±3.30 in PFFV group and 10.91±3.06 in SSPF group, that was statistically significant. The loss of correction from immediate post-operative to final outcome was 3.74±2.18 in PFFV group and 5.43±2.41 in SSPF group, this was also statistically significant (p<.05). Conclusion: Functional and neurological outcome were similar in two techniques. But the intermediate screw fixation technique is better in maintainnance of kyphotic correction.