K. Chandra Sekhar Rao1, Bachu Srinivas2, Ananthula Krishna Reddy3, Saive Siddhartha4
With the increased incidence of road traffic accidents and industrial trauma, there has been a significant increase in the number of thoraco- lumbar spinal injuries. Decompression and early fusion with instrumentation is a generally accepted treatment method for patients with unstable injuries and with a neurological deficit; it helps in early mobilization, and avoids the complications of prolonged recumbency. The pedicle screw-rod system is versatile in that it stabilizes the three columns of the spine. The pedicle is the strongest part of the vertebra and is the force nucleus of the vertebral body. Through the pedicle all forces are transmitted from posterior elements to the vertebral body. Therefore, by fixation of the vertebral body through the pedicle, significant strength of the entire vertebral complex is possible. In our study we operated on 28 patients of unstable thoraco-lumbar injuries, where we performed Moss-Miami instrumentation (pedicular screw rod fixation). All the cases were followed up for a minimum of one year. In all these cases we had favorable results. There was a reduction of an average pre-op kyphotic angle of 15.8º to an average post-op kyphotic angle of 6.6º. We also noted significant neurological improvement as assessed by Frankel grading. In this study, we found that the transpedicular fixation with screws and rods system is effective in the treatment of unstable thoracolumbar spinal injuries. Although the prognosis of the neurological injury seems to be largely determined at the time of trauma, surgical decompression will definitely improve the neurologic deficit in incomplete cord injuries. Cases where there is complete neurologic deficit with no hope for recovery, will also be benefited from surgical fixation in terms of early mobilization and rehabilitation.
