EVALUATION OF SHORT SEGMENT VERSUS LONG SEGMENT POSTERIOR STABILIZATION FOR MANAGEMENT OF TRAUMATIC THORACOLUMBAR SPINE INSTABILITY

Abstract

Traumatic spinal fractures of the thoracolumbar area represent approximately 90% of all spinal fractures.Unstable fractures at the thoracolumbar junction often require surgical intervention. The goals of surgery are to decompress the neural elements, reduce the fracture, and stabilize the spine with fixation until arthrodesis is achieved. Short-segment constructs typically span the levels immediately adjacent to the fracture, but unacceptable failure rates with this technique have been reported. Although short segment stabilization approach, one level above and one level below, has high failure rate, it become preferred approach after renovation by addition of screws into the fractured level (index level). The aim of this prospective study which is evaluation the clinical (biomechanical stability , pain and neurological status), and radiological (correction of kyphotic angle, sagittal plane and spinal fusion) outcome of short segment versus long segment posterior stabilization using transpedicular screws for management of thoracolumbar spine fracture instability was achieved. Sixty one cases were operated, Thirty three cases underwent short segment posterior stabilization and the other twenty eight underwent long segment posterior stabilization, and all cases evaluated over a period of 3 years . The fractured level showed highest incidence in L1 (37.7%) then L2 (29.6%) followed by D12 (23%) and least incidence in D11 (6.6%)and D10 (3.3%).Most of falling from height cases have had L1 or L2 fracture. The short segment group (54.1%) and long segment group (45.9%) were randomly selected from all admitted cases fulfilling the inclusion criteria. We underwent the surgery for all cases with kyphosis angle (10˚-25˚) and after one year post-operative follow up the kyphosis angle became (4˚-12˚). The pain relief was our second main target and almost all cases was complaining of pain with variable degree and according to VAS scale they had pre-operative range (1-9) while one year post-operative VAS scale range was (1-3). This study have showed that screws in the fractured vertebrae can decrease the stress of screws in the upper and lower normal vertebrae to reduce the incidence of screw fracture Second, short-segmental fixation combined with intermediate screws can improve the stress distribution of the internal fixation system and protect the uninjured vertebra and intervertebral disk. Rapid pain relief among short segment group than long segment one and the pain became minimal after fusion occurred. The neurological status did not affected by the type of fixation; it was affected by the initial trauma insult and adequate surgical decompression. So, both groups showed the nearly the same neurological outcome.