A Clinical Study of Single Stage Postero-Lateral Transpedicular Decompression with Screw Rod Fixation in Traumatic ThoracoLumbar Spinal Injuries
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 1
Abstract
Background: Thoracolumbar fractures occur from any and all forms of trauma and are the commonest spinal injuries. About twenty percent of them may be associated with neurological deficits[1,2]. In India however Dorsolumbar fractures are often associated with neurologic deficit and present a significant economic burden to the family and society [3]. The management of thoracolumbar fractures continues to evolve [4]. It remains difficult, however, to prove that surgical treatment provides an increased potential for neurological recovery. Also, the role of a decompressive laminectomy is still unclear [5]. Accepted methods of treatment of dorsolumbar burst fractures include conservative therapy, posterior reduction and instrumentation and anterior decompression and instrumentation. Early mobilization and rehabilitation is the most important aim of the management [6,7]. Operative decompression and internal fixation has become an accepted method of treatment of patients with unstable fracture with partial neurological deficit. Harrington’s distraction instrumentation has its own limitations like decreased flexibility of spine, implant breakage, loss of fixation and loss of lumbar lordosis [8]. The search for an ideal implant which could provide segmental rigid fixation and yet allow early immobilization without support has continued. Steffee [9] in 1986 reported a pedicular screw placement based on the concept of force nucleus of the vertebral body pedicle. The Steffee plate system is a versatile implant which can be used in traumatic, degenerative and neoplastic disorders of the spine. In the present scenario surgical reconstruction and fusion form the treatment of choice for unstable thoracolumbar fractures. The goal of the treatment of unstable thoracolumbar injuries is optimizing neural decompression while providing stable internal fixation over the least number of spinal segments [10]. Either anterior or posterior or both the approaches can be used to achieve fusion but the efficacy of either approach is the same[11,12,13]. However posterior approach is less extensive [14]. Pedicle screw devices allow immediate stable fixation as the screws traverse all the three columns. The pedicle screws are passed one or two levels above and one or two levels below the injured vertebra via posterior approach. The posterior decompressive laminectomy has fallen out of favour with reports now suggesting that neurological deterioration cold result following the procedure [15,16,17]. The anterior approach allows for excellent exposure of the vertebral body, however the procedure is associated with significant post-operative morbidity and a second procedure may be needed for posterior stabilization of the spine [18]. The transpedicular approach allows for a single stage vertebral body decompression, graft placement and fixation. The procedure is cost effective and allows early mobilization of the patients [16-18]. In this study we want to assess our results of single staged posterior transpedicular decompression of fractured vertebral body compressing the spinal cord.
Authors and Affiliations
Chanumolu Praveen, K V V Satyanarayana Murthy, B Chandrasekhar, I Babji Syam Kumar, G Penchalaiah, Gottipati Bindu Narmada
Keywords
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- EP ID EP444741
- DOI 10.9790/0853-1801153864.
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