Does Instrumentation of the Fractured Level in Thoracolumbar Fixation Affect the Functional and Radiological Outcome?

Riaz Mohammed, Roberto Carrasco, Rajat Verma, Saeed Mohammad, Irfan Siddique, Mahmoud Elmalky

Research output: Contribution to journalArticlepeer-review


Study Design: Retrospective comparative study.Objectives: To compare radiological and functional outcomes of patients with fixation constructs utilizing pedicle screw stabilization at the fracture level (FL group) versus patients with non-fracture level (NFL group) fixation in single level fractures of thethoracolumbar junction (T11-L1).Methods: 53 patients of whom fracture level screw was used in 34 (FL group) were compared to 19 patients in NFL group.Radiological parameters analysed were sagittal index, bi-segmental kyphosis (Cobb) angle and degree of vertebral heightrestoration. Prospectively collected patient reported functional outcomes and post-operative complications were also studied.Stepwise regression analysis adjusted by age, gender and functional scores was performed to account for the small numbers andunequal sizes of the groups.Results: Back pain score was significantly lower in the FL group (P < 0.025). Core Outcome Measures Index scores and leg painscores, though low in the FL group, were not statistically significant. The regression analysis showed that the inclusion of thefracture-level screw was independently associated with a greater change in sagittal index and vertebral height restoration post-operatively. Sagittal index was maintained through to final follow up as well. The bi-segmental Cobb’s angle correction was notassociated with fracture-level screw construct. There was no significant difference between the groups for revision surgery, deepinfection, implant failure or length of hospital stay.Conclusion: The inclusion of the fracture-level pedicle screws in the fixation construct significantly improves the immediate andfinal measured radiological parameters, with improved functional scores in single level unstable vertebral fractures of thethoracolumbar junction.
Original languageEnglish
JournalGlobal Spine Journal
Early online date3 Feb 2021
Publication statusPublished - 3 Feb 2021


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