TRANSPEDICULAR FIXATION FOR LOWER THORACIC AND LUMBAR SPINE INJURIES

Objective.To analyse results of surgical teratment of lower thoracic and lumbar spine injuries with transpedicular fixation alone and in combination with other types of stabilization. Material and Methods. A total of 90 patients with fractures of the spine were operated on with the help of transpedicular fixation (TPF). Out of them 35 % had stable injury, 65 % – unstable; fracture was complicated in 59 cases, uncomplicated in 31 cases. The surgical approach depended on injury type, complication absence or presence, and kyphotic deformity magnitude. Complete and incomplete comminuted uncomplicated fractures were treated with transpedicular fixation alone or in combination with posterior fusion or tunnel corporoplasty with porous NiTi granules. Complicated comminuted fractures with adjacent disc injury were treated in two stages: first stage – extended laminectomy, spinal cord anterior decompression, and transpedicular fixation, and second stage – anterior fusion simulteneously or after patient stabilization. Results. Long-term outcomes of transpedicular fixation were analysed in 50 patients in follow-up period of 1 to 5 years. The smallest loss of obtained deformity correction was observed in cases of incomplete stable comminuted fractures (4.5° ± 0.9°), the largest – in those of complete and incomplete unstable fractures (9.9° ± 0.2°), and intermediate loss – in cases of complete stable fractures (7.9° ± 1.1°). The treatment result was good in 40 patients, satisfactory in 7, and unsatisfactory – in 3. Conclusion. Primary and permanent stabilization of injured spinal motion segments in unstable complicated and uncomplicated comminuted fractures in lower thoracic and lumbar spine should be performed by means of anterio-posterior fusion.