Comparison of correction of kyphotic deformity and implant failure in percutaneous short-segment pedicle screws fixation with index level versus long-segment pedicle screws fixation without index level for traumatic thoracolumbar junctional fractures: A prospective cohort study.

OBJECTIVE

To compare correction of kyphotic deformity (KD) and implant failure (IF) in percutaneous short-segment pedicle screws fixation (SSPF) with index level versus long-segment pedicle screws fixation (LSPF) without index level for traumatic thoracolumbar (TL) fractures.

METHODS

This prospective study comprised 56 patients who met the study's inclusion criteria from the Department of Neurosurgery at the Punjab Institute of Neurosciences in Lahore, Pakistan presented between June 2022 and May 2023. We separated them into two groups: Group-A and Group-B, each with 28 patients. Group-A consisted of percutaneous SSPF with incorporated screws in the fractured vertebra, whereas Group-B consisted of percutaneous LSPF without index level involvement for traumatic TL fractures. We reviewed the patient's preoperative, postoperative, and follow-up radiographs. The quantitative factors such as Cobb's angle and implant stability were investigated.

RESULTS

The study comprised individuals with a mean age of 31.5 ± 10.6 SD years. Out of 56 patients, 38 (67.85%) were male and 18 (32.14%) were female. The fracture level distribution was 37 (67.07%) patients with L1 fracture, 15 (26.78%) with D12 fracture, 2 (3.57%) with D11 fracture, and 2 (3.57%) with L2 fracture. Group-A had a preoperative Cobb's angle of 18.8° ± 5.0° SD, whereas Group-B had 19.8° ± 6.3° SD (P-value=0.23). Immediate postoperative Cobb's angle was 6.4° ± 3.4° SD in Group-A and 7.3° ± 3.7° SD in Group-B (P-value 0.66). After three months, Group-A had a Cobb's angle of 7.1° ± 3.6° SD, whereas Group-B had 7.8° ± 3.7° SD (P-value = 0.78). Six-month follow-up Cobb's angle was 7.9° ± 3.6° SD in Group-A and 8.4° ± 3.8° SD in Group-B (P-value=0.502). There were no implant failures in any group.

CONCLUSIONS

For a single level traumatic TL fracture, SSPF with index level can preserve Cobb's angle better than LSPF without index level, and it has high IF stability.