Evaluation of Safety & Accuracy of Decompression and Transpedicular Fixation of Dorsal Column in Traumatic Fracture

Abstract

Object: Transpedicular instrumentation systems afford notable benefits, such as inflexible segmental stabilization, achieving stability of the three sophisticated elements comprising the structure of the spinal column, and it is crucial to emphasize the prospective assessment of the precision and safety of pedicle screw positioning analysis for unstable fractures management in the dorsal spine. Methods and patients: This prospective investigation was carried out over a duration of two years at Erbil Teaching Hospital, spanning from January 2015 to March 2021. A total of 46 patients, comprising of individuals of both sexes (38 males and eight females), Individuals spanning the ages of 16 to 70 were enlisted in the research, with an average age of 43 years among the participants. Stabilization of the fractures surgically on the posterior side was performed by using pedicular screws prior to being discharged. Each patient received postoperative thoracic CT imaging with 3mm axial sections and sagittal reconstructions for the assessment of pedicular screw placement. Results: Records documenting after-operation follow-ups within five months were reviewed. Out of the 402 pedicle screws inserted in the thoracic region, 266 (66.19%) were the entirety of them resided enclosed in the wall of the pedicle, whilst the residual 136 (33.8%) exhibited a deviation from the pedicle wall. Out of the total 136 cases of deviation, 72 (52.9%) were found to be lateral perforations, while 54 (39.7%) were identified as medial perforations, and 10 (7.35%) were categorized as anterior perforations. The prior-to-operation average of the vertebral body kyphosis was 29.50 with a standard deviation of ±5.10. The last follow-up measurement showed a reduction to 13.30 with a deviation from the norm of ±2.60. The average vertebral compression height prior to surgery was 0.2.1 with a deviation from the norm of ±0.03, whereas at the last follow-up, it was 0.16 with a standard deviation of ±0.02Prior to surgery. No detrimental neurological, vascular, or visceral impairments were identified during or after the procedure. Conclusion: Surgical intervention involving decompression and posterior instrumentation through the implementation of pedicle screws and rods has culminated in efficacious canal decompression and superior anatomic reinstatement; this study demonstrates that it is feasible to achieve a reasonably corrected kyphotic deformity in unstable fractures of the dorsal spine with a high degree of accuracy that is considered acceptable. However, it is important to note that even experienced surgeons may encounter the occurrence of an unacceptable screw placement.