Evaluation of neurological and Radiological results of Posterior instrumentation with and without Distraction for thoracolumbar fractures

Abstract

Thoracolumbar fractures are the most common spinal fractures because the biomechanical transition region from the stiff thoracic spine to the more flexible lumbar spine. However, despite the high prevalence of these fractures, there has always been a disagreement in choosing the surgical approach to this type of fracture. This study intends to Evaluation of neurological and Radiological results of Posterior instrumentation with and without Distraction for thoracolumbar fractures. Methods : in this randomized controlled trial study 60 patient with a thoracolumbar spine fracture following a spine trauma from 2016 to 2018 who was admitted to Imam Reza Hospital in Tabriz and candidate for Posteroletrals spinal fusion were performed with pedicular screws and rod implants. In this study, patients were divided into two groups without distraction (n = 30) and the group with distraction (n = 30). Then, neurological status base on modified franklin scale and Radiographic parameters such as kyphotic angle , anterior and posterior height of the vertebral body at admission, postoperation and 3 months follow up period were collected for radiological outcome evaluation. The results were analyzed by SPSS software (ver.21). Results : 60 patients who met inclusion critria were divided into two groups with distraction including 30 patients and without distraction containing 30 patients. The mean age of patients in the study was 11.11 ± 27 27.13 years. The most common site of trauma was the T12 vertebra (26%) followed by the L1 vertebra (21.7%). In this regard, there was no significant difference between the two groups. Upon admission to the hospital, 40% of patients had positive neurological symptoms and 60% were Frankel Grade E. There was no significant difference in Frankle classification between patients in the study groups. x² = 4.763 and P = 0.32 In the three-month follow-up, there was no difference in the neurological symptoms of patients in the two groups. x² = 3.455 and P = 0.48 The difference between the percentage of posterior vertebral collapse and the percentage of anterior vertebral collapse in the postoperative day in the group with distraction was significantly higher than the group without distraction (79.50 ± 12.41, 75.80 ± 16.24 vs 69.50 ± 13.73, 65.53 ± 18.53) (p value = 0.004, 0.28 respectively) and also the kyphosis angle was 3.87 ± 4.87 in the group with distraction and 2.77 ± 2.44 in the group without distraction, which was statistically significant( P value = 0.009) but in the follow-up only Posterior vertebral collapse in the group with distraction was significantly higher than the group without distraction. Conclusion: Based on the findings of this study, there was no significant difference between the modified Frankel criterion between the two groups with and without distraction before and after surgery and follow-up. Also, in comparison with radiographic findings, the posterior vertebral collapse percentage and the anterior vertebral collapse percentage and local kyphosis angle in the immediately postoperative graph were significantly lower in the distraction group. Both groups had reduced the percentage of posterior vertebral collapse and the percentage of anterior vertebral collapse as well as kyphosis angle and the only significant difference in the final follow-up was the rate of posterior vertebral collapse in the group with distraction.