Treatment of traumatic unstable thoracolumbar junction fractures with transpedicular screw fixation

Objective: To assess the effectiveness of transpedicular screw fixation in neurological recovery and pain control in thoracolumbar junction injuries. Method: This audit was carried out in the Neurosurgery Department of Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar from November 2008 to April 2010. Written informed consent was taken from all patients. Detail history, clinical examination, x-ray dorsolumbar spine (or CT scan dorsolumbar spine) and MRI dorsolumbar spine were done in all cases. Neurological status was assessed using the Frankel grading for spinal cord injury. Post traumatic unstable thoracolumbar junction fractures were included in this study. Open fractures, fractures with significant kyphotic deformity, fractures with anterior retropulsed fragments, multiple level fractures requiring long segment fixation, pedicles fractures and pathological fractures were excluded from study. The short-segment transpedicular fixation was performed in all patients. Effect of transpedicular screw fixation on pain relief was measured by improvement in Dennis pain scale. History of pain relief and neurological assessments of patients were done on each follow up visit. The data was analyzed in SPSS 16.0. Results: Transpedicular screw fixation was performed in 80 patients including 55 males and 25 females. Mean age was 35 +/- 6.75 years (range 15-61 years). The level of injuries were D11=6(7%) cases, D12 =13(16%) cases, L1=40(50%) cases, L2=15(19%) cases, D12 & L1=6(8%) cases. There were 43(54%) Wedge fractures, 9(11%) fracture subluxations, burst fracture in 14(17%), translational injuries in 8 (10%) while distraction injuries in 6(8%) cases. Pre operative neurological status according to Frankel grading was: grade A, 48(60%) cases, grade B 12(15%) cases, grade C 6(7%) cases, grade D 4(5%) cases and grade E 10(13%) cases. Six months post operatively, there were 16(20%) cases in grade A, grade B 34(42.5%) cases, grade C 16(20%) cases, grade D 4(5%) cases and grade E 10(12.5%) cases. Pain control was assessed by improvement in Dennis pain scale. Pre operatively there was no patient in P1, 4(5%) patients in P2, 16(20%) in P3, 24 (30%) in P4 and 36(45%) in P5.Six months later there were 56(70%) patients in P1,16 (20%)in P2,4(5%) in P3 and 4(5%) patients in P4.There was no patient in P5. Conclusion: Thoracolumbar junction injuries are common in young male patients. Transpedicular screw fixation is useful choice for achieving better neurological recovery and good pain control in traumatic thoracolumbar fractures.