Short Segment Posterior Instrumentation with Intermediate Screw in Thoracolumbar Junction Injury: Prospective Study
Iraqi Postgraduate Medical Journal,
2021, Volume 20, Issue 2, Pages 116-127
Thoracolumbar fractures are traditionally treated surgically by short segment fixation;
however, they may be associated with high implant failure. The insertion of an additional screw at
fracture site makes it more stable with a better clinical outcome.
The aim was to evaluate the radiological and clinical parameters of posterior short
segment fixation with intermediate screw implantation into the fractured vertebra.
We evaluated 30 patients with unstable thoracolumbar fractures, managed with short
segment posterior instrumentation with intermediate screw in the fractured vertebra; fractures
classification was done according to AOspine and TLICS systems . Eighteen male and 12 females
qualified for the study; male to female ratio was 1.5:1; average age 28.86 years. Neurological status
was classified according to the ASIA impairment scale. Pain was evaluated by VAS score. The
percentage of vertebral body collapse and segmental kyphosis were assessed by Cobb method.
Duration of follow-up lasted for 12 months.
The mean preoperative VAS score was 8.55, had significantly improved to 0.87 at final
follow up. Preoperative mean vertebral body collapse was 48.40%, which had significantly improved
to 12.85% at final follow up. Mean segmental kyphotic angle was 21.83° before surgery, final mean
segmental kyphosis was 8.63°. Fifteen patients with incomplete neurologic deficits had improvement
by at least one ASIA grade on final follow-up observation, and 2 of 4 patients with complete
neurologic deficit remained unchanged. All neurologically intact patients remained unchanged. None
of patients had implant failure.
Short segment fixation with intermediate screws in treatment of thoracolumbar junction
fracture effectively improve stability with most of patients achieve significant improvement in clinical
- Jitaru, Ioana Viorela, et al. Thoracolumbar spine injuries: A retrospective study on 651
cases. Romanian Neurosurgery. 2018: 573-582.
- Chapman JR, Agel J, Jurkovich GJ, et al. Thoracolumbar flexion distraction injuries: associated
morbidity and neurological outcomes. Spine. 2008; 33: 648-657.
- Sheridan R, Peralta R, Rhea J, et al. Reformatted visceral protocol helical computed tomographic
scanning allows conventional radiographs of the thoracic and lumbar spine to be eliminated in the evaluation of blunt trauma patients. J Trauma. 2003; 55: 665-69.
- Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma: An overview. Indian J Orthop. 2015;49:72-82. doi:10.4103/0019-5413.143914
- ASIA and ISCoS International Standards Committee. The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)-What's new? Spinal
Cord. 2019 ;57:815-17.
- Chiarotto, Alessandro, et al. "Measurement properties of visual analogue scale, numeric rating
scale, and pain severity subscale of the brief pain inventory in patients with low back pain: a
systematic review." The Journal of Pain 20.3 ,2019: 245-263.
- Joaquim, Andrei Fernandes, et al. "Thoracolumbar injury classification and injury severity score
system: a literature review of its safety." Global spine journal 6.1 , 2016: 80-85.
- Vaccaro, Alexander R., et al. "AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers." Spine 38.23 ,2013: 2028-37.
- Hsu, Wei-En, et al. "The Evaluation of Different Radiological Measurement Parameters of the
Degree of Collapse of the Vertebral Body in Vertebral Compression Fractures." Applied bionics and biomechanics 2019 (2019).
10. Keynan O, Fisher CG, Vaccaro A et al. Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the spine trauma study group. Spine
2006; 31: E156–E165.
11. SPINEART, GENEVA, SAChemin du Pré-Fleuri 3, 1228 Plan-les-Ouates; SWITZERLAND, 2018, website: spineart.com.
12. Aly, Tarek Ahmed. "Short segment versus long segment pedicle screws fixation in management of thoracolumbar burst fractures: meta-analysis." Asian Spine Journal 11.1 ,2017: 150.
13. Butt MF, Farooq M, Mir B et al. Management of unstable thoracolumbar spinal injuries by
posterior short segment spinal fixation. Int Orthop 2007 31:259–64.
14. Sait, Azad, et al. "Biomechanical comparison of short-segment posterior fixation including the fractured level and circumferential fixation for unstable burst fractures of the lumbar spine in a calf spine model." Journal of Neurosurgery: Spine 25.5 .2016: 602-9.
15. Farrokhi MR, Razmkon A, Maghami Z, Nikoo Z. Inclusion of the fracture level in short segment fixation of thoracolumbar fractures. Eur Spine J 2010; 19:1651–56.
16. Raja RA. Management of thoracolumbar spine injuries at a tertiary care hospital. J Ayub Med Coll Abbottabad. 2010; 22: 171-75.
17. Chokshi, Jimmy Jyotinbhai, and Manish Shah. "Outcomes of including fracture level in shortsegment fixation for thoracolumbar fracture dislocation." Asian spine journal 13.1 . 2019: 56.
18. Viswanathan, Vibhu Krishnan, and Rishi Mugesh Kanna¹. "Management of thoracolumbar fractures in adults: Current algorithm." (2019).
19. Verlaan, J. J., et al. "Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome." Spine 29.7.2004: 803-814.
20. Ahsan, Md Kamrul, et al. "Posterior fixation including the fractured vertebra in short segment fixation of unstable thoracolumbar junction burst fractures." Bangabandhu Sheikh Mujib Medical University Journal 9.2 . 2016: 81-87.
21. Shetty, Mithun. "Dheeraj Kumar V1, Mithun Shetty2, C. Kunal Kushalappa3." International
Journal of Orthopaedics 5.01 . 2019: 59-66.
22. Guven O, Kocaoglu B, Bezer M, Aydin N, Nalbantoglu U. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech 2009; 22:417–21.
23. Ozdemir, Bulent, et al. "Restoration of anterior vertebral height by short-segment pedicle screw
fixation with screwing of fractured vertebra for the treatment of unstable thoracolumbar
fractures." World Neurosurgery 99 .2017: 409-17.
24. Ye, Conglin, et al. "Comparing the efficacy of short-segment pedicle screw instrumentation with and without intermediate screws for treating unstable thoracolumbar fractures." Medicine 96.34(2017). McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine. 1994;19:1741-44.
25. Kose KC, Inanmaz ME, Isik C, Basar H, Caliskan I, Bal E. Short segment pedicle screw
instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine. Bone Joint J. 2014; 96-B :541-7.
26. Mahar A, Kim C, Wedemeyer M, et al. Short segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976). 2007; 32:1503-7.
27. Du XR, Zhao LX, Shi JC, Kong XY. Clinical anatomy of the reduction and fixation through the pedicle of the injured vertebrae for the treatment of the thoracolumbar or lumbar burst fractures [in Chinese]. Chinese J Clinical Anat. 2007; 25:239-42.
28. Andress HJ, Braun H, Helmberger T, Schurmann M, Hertlein H, Hartl WH. Long-term results after posterior fixation of thoracolumbar burst fractures. Injury. 2002; 33:357-65.
29. Sun, Xiang-Yao, Xi-Nuo Zhang, and Yong Hai. "Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: a m eta-analysis." European spine journal 26.5 .2017: 1418-31.
30. Cahueque, Mario, et al. "Management of burst fractures in the thoracolumbar spine." Journal of orthopaedics 13.4 . 2016: 278-81.
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