Clinical Evaluation Of Posterior Short Segment Pedicle Fixation For The Treatment Of Thoracolumbar Fractures

Objective: To evaluate the clinical results and safety of pedicle screw fixation for the treatment of all kinds of the thoracolumbar fractures. Methods: from January 1998 to December 2002, 300 patients (245 males and 55 females) with an average age of 36 in the male and an average age of 35 in the female underwent short-segment pedicle instrumentation for thoracolumbar fractures. The classification of Denis was used to describe the fracture patterns, including 30 cases of compression fractures, 163 cases of burst fractures, 85 cases of fracture-dislocations, 22 cases of chance fractures. Of the 300 patients, one hundred and twenty-eight cases fell, one hundred and one cases were injured by a falling object, sixty-two cases were injured by a motor vehicle, one case was injured by twist, one case was injured by bump, four cases tumbled, and three cases were injured by compression. Two hundred and sixty-three had a single-level fracture, thirty-two had a two-level fracture and five had three-level fracture. The fracture segment was within T3-L5. A total of 84% were thoracolumbar fracture. The instrumentations were as follows: Dick 41 cases, Steffee 41 cases, AF 184 cases, RF 5 cases, Hoist 15 cases, Uss 6 cases, AIUR 4 cases, TSRH 2 cases, Tenor 1 cases, xie-he plate 1 case. The method of insertion of transpedicular screw were Weinstein's method and the method of "∧" shape crest. All patients were treated with pedicle screw fixation under C-arm fluoroscopy. Result: 300 patients had no long follow-up. So we can only analyze the recently clinical data. 300 patients had no worsening of neural injury. Neurological status improved Frankle 0.4 grade on an average at week 1 after operation in the patients who had preoperative paraplegia, while no improvement was obtained in these who had preoperative complete paraplegia. The mean reduction rate was 93.7%. Complication occurred in 25 cases in which 15 cases occurred during operation with the incidence 5%, while 10 occurred after operation with the incidence 3.3%. Conclusion: pedicle screw fixation of short segment with satisfactory clinical results in treating all kinds of thoracolumbar fractures. A successful operation should include appropriate operation timing, perfect surgical technique, reliable spinal fusion, and adequate decompression.