# Evaluating the Role of Intermediate Screws in the Early Healing of Traumatic Thoracolumbar Fractures Managed by Short-Segment Fixation

## TL;DR

This study examines how adding intermediate screws in short-segment spinal fixation helps heal thoracolumbar fractures more effectively while preserving spine mobility.

## Contribution

The study introduces the use of intermediate screws in short-segment fixation for traumatic thoracolumbar fractures and evaluates its impact on healing and mobility.

## Key findings

- Intermediate screws significantly improved the mean kyphotic angle by 14.5° over one year.
- Most patients (77%) had no complications, and mobility was preserved without implant failure.
- Neurological outcomes improved, with 40% of patients reaching AIS E at one year.

## Abstract

Introduction

Thoracolumbar (TL) fracture is one of the leading problems in orthopedic practice, more so in the modern era, where individuals are more at risk due to high-energy trauma. By definition, the thoracolumbar region of the spine spans from T11 to L2. The TL region accounts for around 60%-70% of all traumatic spinal fractures. The instrumentation of this region is still highly debatable, but in the modern era, posterior short-segment transpedicular screw fixation, which offers shorter operating times, less intraoperative blood loss, and better motion preservation is preferred for fixing these fractures over long-segment fixation (LSF). Intermediate screw fixation at the fractured vertebrae provides stability without compromising the mobility of the spine.

Methods

A prospective observational study was undertaken in the Department of Orthopedics of Indira Gandhi Institute of Medical Sciences, Patna, from August 2022 to March 2024. Thirty thoracolumbar injury patients who gave consent for surgery, admitted during the study period, were included in the study. After surgical fitness, patients underwent the operation. Polyaxial pedicle screws were inserted using intersection technique; first, screws were inserted above and below the fractured vertebrae and then in the fractured pedicle after checking the pedicle morphology. Clinical examination and neurological charting per the American Spinal Injury Association (ASIA) Impairment Scale (AIS) were done during admission and follow-up. Radiological examinations were done for all patients. Patients were followed up at six weeks and three, six, and 12 months.

Results

A total of 30 patients (20 male and 10 female patients) were included in our study. The mean age of the patients was 32.9 (range: 18-60) years. The most common cause of thoracolumbar injuries was fall from height (23, 77%); other causes include road traffic accidents (RTAs) (7, 23%). The most common vertebra involved in this study was L1 (12, 40%); other involved the D12 and L2 vertebrae. The most common pattern was compression fracture (21, 70%), followed by burst fracture (9, 30%). The mean duration from injury to hospital admission was 8.33±10.73 days. The mean duration from injury to surgery was 17.2±11.02 days. The mean duration of hospital stay was 22.9±6.1 days. Six (20%) thoracolumbar fracture patients were operated on within 10 days of injury, and 24 (80%) were operated on after 10 days of injury. Preoperatively, there were four (13.33%) AIS grade A patients, 18 (60%) AIS B, four (13.33%) AIS C, four (13.33%) AIS D, and 0 (0%) AIS E. At the end of one year, there were four (13.33%) AIS A patients, 0 (0%) AIS B, 0 (0%) AIS C, 14 (46.67%) AIS D, and 12 (40%) AIS E. Preoperatively, the mean kyphotic angles were 22.6°±1.2°; at one year, the mean kyphotic angle was 8.1°±1.1°. The mean difference between the preoperative and one-year postoperative period was 14.5°. The p-value was less than 0.0005; there was a significant difference between preoperative and postoperative kyphotic angles. In this study, of 30 patients, 23 (77%) had no complications, three (10%) had pressure sores, two (3.33%) had discharge from the incision site, and two (3.33%) had urinary tract infection (UTI).

Conclusion

Introducing intermediate screw in short-segment fixation (SSF) provides significant improvement in mean kyphotic angle and early signs of fracture healing without implant failure. The mobility of the spine remains intact.