Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology

Abstract

Background: Treatment of unstable thoracolumbar fractures is controversial regarding short or long segment pedicle screw fixation. Although long level fixation is better, it can decrease one motion segment distally, thus increasing load to lower discs.

Methods: We retrospectively analyzed 31 unstable thoracolumbar fractures with partial or intact neurology. All patients were operated with posterior approach using pedicle screws fixed two levels above and one level below the fracture vertebra. No laminectomy, discectomy or decompression procedure was done. Posterior fusion was achieved in all. Post operative and at final follow-up radiological evaluation was done by measuring the correction and maintenance of kyphotic angle at thoracolumbar junction. Complications were also reported including implant failure.

Results: Average follow-up was 34 months. All patients had full recovery at final follow-up. Average kyphosis was improved from 26.7 degrees to 4.1 degrees postoperatively and to 6.3 degrees at final follow-up. And mean pain scale was improved from 7.5 to 3.9 postoperatively and to 1.6 at final follow-up, All patients resumed their activity within six months. Only 4 (12%) complications were noted including only one hardware failure.

Conclusion: Two levels above and one level below pedicle screw fixation in unstable thoracolumbar burst fracture is useful to prevent progressive kyphosis and preserves one motion segment distally.

Figure 1

showing preoperative a) AP and b) lateral radiogram of a patient with unstable L1 fracture with kyphosis of 28-degrees. Immediate postoperative c) AP and d) lateral radiogram showed correction of kyphosis.

Figure 2

at final follow-up (3 years) a) AP and b) lateral radiogram showed maintenance of correction in kyphosis, and c) flexion and d) extension view showed good lumbar motion with maintenance of correction.