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Journal of Korean Neurosurgical Society 2002;32(4): 334-440.
Thoracic Pedicle Screw Fixation and Fusion in Unstable Thoracic Spine Fractures.
In Ho Han, Geun Sung Song
Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea.
The goal of study is the evaluation of clinical and radiological outcome of thoracic pedicle screw fixation and fusion in unstable thoracic spine fractures.
The authors retrospectively studied 21 patients with unstable thoracic fractures received thoracic pedicle screw fixation and fusion from 1995 to 2001. We analyzed the pre- and postoperative neurological finding(Frankel functional classification), radiological finding(Sagittal index: SI, Percentage of anterior body compression:ABC), complications, and displacement of screws.
All five Frankel E grades remained E grade, 7 of 10 incompletes improved, and 6 complete deficits remained complete. No patients sustained an increase in neurologic deficit. These 21 patients had a mean preoperative SI as 19.3 degrees, which was corrected to 14.4 degrees after operation. After 6 months follow-up, the SI was 14.2 degrees And those had an mean preoperative ABC as 53.8% which was corrected to 34% after operation. At 6 months. the mean ABC was 34.4%. A statistically significant difference existed between the preoperative, postoperative and follow-up SI and ABC. The complications were respiratory and urinary tract infection, decubitus et al., but the hardware failure was not occurred. The cortical violation of pedicle screw in 4 patients who had mid-upper thoracic fractures was 26.7%, but the displacement was less than 2 millimeter and any neurological, cardiovascular, or pulmonary injury were not revealed. The bone fusion and stabilization was successful in all patients.
Pedicle screw fixation and fusion is an effective and safe method in unstable thoracic spine fractures, because of high fusion rate, good neurological and radiological outcome and low complication rate. Mild displacement of pedicle screw does not affect the clinical outcome. So, pedicle screw fixation can be an acceptable procedure in unstable mid-upper thoracic spine fracture or dislocations.
Key Words: Unstable thoracic spine fracture; Pedicle screw fixation and fusion; Cortical violation; Mid-upper thoracic spine
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