Fractures of thoracolumbar spine: monosegmental fixation

Abstract

We studied 18 patients with fractures of the thoracolumbar spine undergoing the surgical treatment of posterior monosegmental fixation and arthrodesis. Patient follow-up ranged from 2-12 years (mean: 6.65+/-2.96), and the patients were assessed by clinical evaluation, radiographic study, and functional evaluation. The parameters used for clinical evaluation were the Denis pain scale and neurological evaluation by the Frankel scale, while a subjective evaluation of the final result was made by the patients themselves. Kyphosis of the injured vertebral segment, the height of the disk of this segment, and the presence of bone reabsorption around the implant were the parameters used for radiographic evaluation. Functional evaluation was performed by: the Denis work scale; the Oswestry disability index; and the SF-36 questionnaire. Clinical evaluation revealed low residual pain rates and a high level of patient satisfaction with the final result. Functional evaluation showed that 95.5% of the patients returned to work on a full-time basis, presented with a low disability index (Oswestry=10.33) and followed the profile of the North American population when assessed by the SF-36 questionnaire. Radiographic evaluation revealed increased kyphosis in the fixed vertebral segment during the late postoperative period, accompanied by a reduced height of the intervertebral disk. There was no implant break, and no signs of pseudoarthrosis were observed in any patient. The clinical, functional, and radiographic results observed show that posterior monosegmental fixation is an adequate and satisfactory procedure to be used in specific types of thoracolumbar spine fractures.