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Evaluation of Pedicular Screw Efficiency in the Treatment of Unstable Upper and Middle Thoracic Spine Fractures
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A.A .Ghasemi *   |
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Abstract: (7615 Views) |
ABSTRACT
BACKGROUND AND OBJECTIVE: Treatment of unstable upper and middle thoracic spine (T1-T10) fractures is challenging because of the high rate of associated injuries and frequent spinal cord injury. In spite of this importance, literature has not been addressed exclusively about this condition. Various surgical modalities have been reported for it and main advantage of surgery is restoration of sagittal and coronal alignment of vertebral column and spinal cord decompression. In this study, the results of surgery by using pedicular screw in these patients were assessed.
METHODS: In this quasi-experimental study, 16 patients (14 males and 2 females) with the mean age of 31 years (17 to 63 years) with unstable upper and middle thoracic spine (T1-T10) fractures who underwent surgery during three years (2009-2011) were assessed. Polyaxial pedicle screw was used in all patients two level above and below the fractured vertebra. Mean follow-up period was 16 months (9 -22 months). Radiologic evaluation was performed before and after surgery with plain X-ray, and degree of kyphosis and anterolisthesis was calculated before and after surgery. Neurologic injury to spinal cord before surgery and the amount of improvement after surgery was assessed by American Spinal Injury Association (ASIA). Instability was described by 3 column theory of Denis.
FINDINGS: Each of three variables ie kyphosis, anterolisthesis, neurologic deficit has been improved (p<0.05) with pedicular screw fixation technique. Kyphosis has been reduced up to 12 degrees, anterolisthesis decreased up to 7mm. From neurologic point of view 10 patients remained unchanged (ASIA A) but 4 patients improved dramatically from ASIA B to ASIA D and 2 patients remained neurologically intact as well (ASIA E).
CONCLUSION: Surgery with pedicular screw and rod is a safe procedure for treatment of unstable upper and middle thoracic spine fractures that could efficiently correct kyphotic deformity and anterolisthesis and indirectly decompress the spinal cord and can improve neurologic status and maintain this correction in long term period.
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| Keywords: Spinal cord injury, Thoracic spine fractures, Pedicular screw. |
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Full-Text [PDF 171 kb]
(1675 Downloads)
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Type of Study: Research |
Subject:
Biochemical
Accepted: 2014/06/10 | Published: 2014/06/10
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