Predictors of Functional Recovery after Posterior Decompression and Pedicle Screw-Rod Fixation in Unstable Thoracic Spine Pathology

Open Access

Abstract

Introduction: Unstable thoracic spine pathology carries a high neurological risk due to the narrow canal and rigid rib cage, often causing motor, sensory, and autonomic deficits. Posterior decompression with pedicle screw-rod fixation restores stability, but recovery varies. This study aims to identify predictors of functional recovery following this surgical approach. Methods and materials: This study was conducted from January 2021 to December 2023 at the Department of Orthopaedic, Bangladesh Medical University, including 57 consecutive patients with unstable thoracic spine pathology. Patients underwent posterior decompression with pedicle screw-rod fixation. Neurological, functional, and radiological outcomes were assessed pre- and post-operatively at 1, 3, 6, and 12 months using the modified Macnab criteria. Data were analysed using SPSS version 26, including descriptive statistics and logistic regression; p < 0.05 was considered significant. Results: Most patients were middle-aged (mean 39.6 years) and 56.1% female. Post-operatively, bowel-bladder dysfunction fell from 77.2% to 3.5%, full motor recovery occurred in 73.7%, and full sensory recovery in 71.9%. Functional mobility improved, with 56.1% walking with support and 43.9% independently. Excellent outcomes increased to 64.9%, and 78.9% achieved satisfactory recovery. Age >40, absent pre-operative motor or sensory function, bowel-bladder involvement, and post-operative complications were independent negative predictors. Conclusion: Posterior decompression with pedicle screw-rod fixation provides significant neurological and functional improvement in patients with unstable thoracic spine pathology.