FRACTURE OF SPINE: UNSTABLE FRACTURE OF THE THORACOLUMBAR SPINE, TO DETERMINE THE EFFECTIVENESS OF PEDICLE SCREW AND ROD FIXATION FOR MANAGEMENT

Objectives: In this study we analyze and study the effectiveness of pediclescrew and rod fixation for the management of unstable fractures of the thoracolumbar spine.The type of study is a Study Design: Case series. Period: 1.5 year duration from April 2014 toSeptember 2015. Setting: Tertiary Care Centre in Karachi, Pakistan. Materials and methods:N= 35 patients were operated at our institute and included in the study. The inclusion criteriawas all those patients who presented to us with unstable fractures of the thoracolumbar spinevia the accident and emergency department of the hospital, and were operated upon and gavefull informed consent to partake in the research were included in this study. All the patientswere operated under general anesthesia. The short segment fixation with pedicle screw rodfixation using the posterior approach was the technique utilized for treatment. Rehabilitationwas started immediately after the surgical procedure. Data was analyzed using SPSS version23. Results: The study population consisted of n= 35 patients of which n= 25 (71.42%) weremales and n= 10 (28.57%) were females, the mean age of the study population was 33.5years. A history of fall from height was the most common cause of injury in n= 26 (74.28%)of the patients, next was automobile accidents in n= 9 patients (25.71%). Burst fracture wasthe most common type of injury. The sagittal angle was 23.5O pre operatively and 10.75 O postoperatively, and at follow up the loss of angle was found to be 4.80 respectively. The sagittalindex values were as follows, pre-operative 0.53, post-operative 0.75 and 0.72 at follow up (finalfollow up). N= 30 (85.71%) patients showed improvement in their ASIA status, n= 19 (54.28%)showed single grade improvement, n= 10 (28.57%) showed double grade improvement, n=1 (2.85%) showed triple grade improvement, while n= 5 (14.28%) cases did not show anyimprovement. The mean duration between injury and surgical intervention was 5.5 days witha range of 1 to 23 days, the major cause of this delay was delay in reaching the hospital. Themost common complication observed was pressure sores in n= 4 (11.42%) and urinary tractinfections (UTI) seen in n= 5 (14.28%) of patients, followed by implant failure in n=3 (8.57%)patients. Conclusion: According to the results of our study unstable burst fractures was themost prevalent type of fracture observed, there was a marked improvement in the radiologicalparameters post operatively, while the neurological improvement was decent. The technique ofpedicle screw rod and fixation using the posterior approach provides good surgical outcomeand better stabilization, with a fair amount of neurological improvement for these patients.