MANAGEMENT AND OUTCOME OF SHORT SEGMENT TRANSPEDICULAR SCREW FIXATION AT JPMC KARACHI
Main Article Content
Keywords
Short-segment, fixation, pedicle screw instrumentation, thoracolumbar fracture
Abstract
Objective: To evaluate the management and outcome of lower thoracic and upper lumbar fractures and Spondylolisthesis with short segment transpedicular screw fixation at JPMC Karachi.
Methods: This was a prospective type of study, conducted from April 2023 to March 2024 in Department of Neurosurgery, Jinnah Postgraduate Medical Centre Karachi. All patients admitted with thoracolumbar fractures and went under fixation with short arm transpedicular screw in that period were included and analysed.
Results: In this prospective study of 54 patients (63% males, 37% females; mean age 33.22 years), vertebral fractures were primarily caused by falls from height (44.4%) and road traffic accidents (29.6%). Most patients (70.4%) had fracture-only injuries, predominantly at the thoracolumbar junction (T12-L2) and presented with wedge compression fractures (48.0%) or burst fractures (20.0%). Postoperatively, 59.3% of patients were pain-free, with 60.0% achieving ASIA Grade E neurological status. Physiotherapy was undertaken by 52.4% of patients, with 15.8% returning to their previous job post-surgery. Overall, 7.4% of patients expired. The study findings were statistically significant (p < 0.05).
Conclusion: Short arm Transpedicle Screw fixation has modified the management and outcome of lower thoracic and lumbar fractures with spondylolisthesis. It has improved neurologic status and quality of life of patients.
References
2. Hotfiel, T., Seil, R., Bily, W., Bloch, W., Gokeler, A., Krifter, R. M., Mayer, F., Ueblacker, P., Weisskopf, L., & Engelhardt, M. (2018). Nonoperative treatment of muscle injuries - recommendations from the GOTS expert meeting. Journal of experimental orthopaedics, 5(1), 24. https://doi.org/10.1186/s40634-018-0139-3
3. Karimi M. (2015). The effects of orthosis on thoracolumbar fracture healing: A review of the literature. Journal of orthopaedics, 12(Suppl 2), S230–S237. https://doi.org/10.1016/j.jor.2015.10.014
4. Alcalá-Cerra, G., Paternina-Caicedo, A. J., Díaz-Becerra, C., Moscote-Salazar, L. R., & Fernandes-Joaquim, A. (2014). Orthosis for thoracolumbar burst fractures without neurologic deficit: A systematic review of prospective randomized controlled trials. Journal of craniovertebral junction & spine, 5(1), 25–32. https://doi.org/10.4103/0974-8237.135213
5. Verheyden, A. P., Spiegl, U. J., Ekkerlein, H., Gercek, E., Hauck, S., Josten, C., Kandziora, F., Katscher, S., Kobbe, P., Knop, C., Lehmann, W., Meffert, R. H., Müller, C. W., Partenheimer, A., Schinkel, C., Schleicher, P., Scholz, M., Ulrich, C., & Hoelzl, A. (2018). Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global spine journal, 8(2 Suppl), 34S–45S. https://doi.org/10.1177/2192568218771668
6. Celikoglu, E., Borekci, A., Ramazanoglu, A. F., Cecen, D. A., Karakoc, A., & Bektasoglu, P. K. (2019). Posterior Transpedicular Screw Fixation of Subaxial Vertebrae: Accuracy Rates and Safety of Mini-laminotomy Technique. Asian journal of neurosurgery, 14(1), 58–62. https://doi.org/10.4103/ajns.AJNS_178_17
7. D'souza, A. R., Mohapatra, B., Bansal, M. L., & Das, K. (2017). Role of Posterior Stabilization and Transpedicular Decompression in the Treatment of Thoracic and Thoracolumbar TB: A Retrospective Evaluation. Clinical spine surgery, 30(10), E1426–E1433. https://doi.org/10.1097/BSD.0000000000000498
8. Al Mamun Choudhury, A., Alam, M. S., Jonayed, S., Dastagir, O., & Jahan, M. S. (2023). Long-Segment Versus Short-Segment Pedicle Screw Fixation Including Fractured Vertebrae for the Management of Unstable Thoracolumbar Burst Fractures. Cureus, 15(2), e35235. https://doi.org/10.7759/cureus.35235
9. Wood, K. B., Li, W., Lebl, D. R., & Ploumis, A. (2014). Management of thoracolumbar spine fractures. The spine journal : official journal of the North American Spine Society, 14(1), 145–164. https://doi.org/10.1016/j.spinee.2012.10.041
10. Rajasekaran, S., Kanna, R. M., & Shetty, A. P. (2015). Management of thoracolumbar spine trauma: An overview. Indian journal of orthopaedics, 49(1), 72–82. https://doi.org/10.4103/0019-5413.143914
11. Sasso RC, Costler HB : Posterior Instrumentation and fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine. Spine 1993;18:450–60.
12. Jindal, R., Jasani, V., Sandal, D., & Garg, S. K. (2020). Current status of short segment fixation in thoracolumbar spine injuries. Journal of clinical orthopaedics and trauma, 11(5), 770–777. https://doi.org/10.1016/j.jcot.2020.06.008
13. Ghasemi, A. A., & Ashoori, S. (2016). Efficacy of Pedicle Screw Fixation in Unstable Upper and Middle Thoracic Spine Fractures. Trauma monthly, 21(1), e28627. https://doi.org/10.5812/traumamon.28627
14. Jacobs RR, Casey MP. Surgical management of thoracolumbar spinal injuries. Clin Orthop Relat Res 1984;189:22–35.
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Dr Pirah Korai
MBBS, FCPS Neurosurgery, Consultant Neurosurgeon, Chandka Medical College Hospital, Larkana, Pakistan
Dr Sajid Hussain
MBBS, FCPS Orthopaedic surgery, Consultant Orthopaedic Surgeon, Chandka Medical College Hospital, Larkana, Pakistan
Dr Muhammad Ali Jamali
FCPS Neurosurgery, Assistant Professor People's University of Medical and Health Sciences, Pakistan
Dr Muhammad Salah Jamali
MBBS.FCPS Neurosurgery, Senior Registrar, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
Dr Usamah Bin Waheed
Senior Registrar Neurosurgery, Liaquat College of Medicine and Dentistry, Karachi
Dr Waqas Mughis
MBBS FCPS Neurosurgery, Senior Registrar Neurosurgery, Jinnah Medical and Dental College, Karachi, Pakistan
Dr Um E Rubab Sandano
FCPS General Surgery, Lecturer, Bibi Aseefa Dental College, Larkana, Pakistan
Dr Veengus Baloch
MBBS, Medical Officer, Chandka Medical College Hospital, Larkana, Pakistan