Outcomes of Including Fracture Level in Short-Segment Fixation for Thoracolumbar Fracture Dislocation

Chokshi, Jimmy Jyotinbhai; Shah, Manish

Abstract

STUDY DESIGN: This was a prospective study of 50 patients of thoracolumbar fracture dislocation treated at a single institution with short-segment fixation with the inclusion of fracture level. PURPOSE: To assess the outcomes of including the fracture level in short-segment fixation for thoracolumbar fracture dislocation. OVERVIEW OF LITERATURE: Traditionally, thoracolumbar fracture dislocation is treated with long-segment posterior fixation. However, to save motion segments, short-segment fixation has been used instead in many cases of thoracolumbar trauma.
METHODS
In this study, 50 patients with thoracolumbar fracture dislocation were treated with short-segment fixation with inclusion of the fracture level; patients with pathological fractures or with a McCormack load-sharing score >6 were excluded. The 50 patients were prospectively followed for at least 1 year. The duration of surgery, blood loss, and complications were noted. The Visual Analog Scale (VAS) score was used to measure pain, and the American Spinal Injury Association (ASIA) scale was used to determine the neurological status at follow-up. Preoperative, immediate postoperative, and final follow-up X-rays were used to measure the kyphotic angle using Cobb's method.
RESULTS
The mean age of our patients was 33.4 years, and the male:female ratio was 1.9:1. The mean follow-up period was 18.4 months (range, 12-23 months). Injuries were mainly at the thoracolumbar junction area (T11-L2, 41 cases, 82%). The average duration of surgery was 94.6 minutes, and the average blood loss was 394.8 mL. Postoperative infection occurred in two cases and implant failure in one case. The kyphosis angle values were as follows: average preoperative, 26.80°±14.50°; immediate postoperative, 4.30°±8.70°; and final follow-up, 5.50°±110°. The ASIA scale and VAS score at final follow-up showed improvement.
CONCLUSIONS
Inclusion of the fracture level in short-segment fixation for thoracolumbar fracture dislocation (McCormack load-sharing score â‰¤6) gives good kyphosis correction and correction maintenance. It can also obviate the need for traditional long-segment fixation.