Session VI - Spine

Fri., 10/6/06 Pediatrics & Spine, Paper #33, 12:02 pm

Surgical Treatment of Traumatic Flexion-Distraction Injuries of the Thoracic Spine: A Retrospective Review of Segmental Pedicle Screw Instrumentation

Samuel A. Joseph, Jr, MD (n); Mark Stephen, MD (*);
Bruce Meinhard, MD (*);
State University of New York Stony Brook University Hospital,
Stony Brook, New York, USA

Purpose: The study was performed to evaluate the ability of isolated posterior segmental thoracic pedicle screw (TPS) instrumentation to correct and maintain the focal kyphosis in flexion-distraction injuries (FDIs). Implant failures, complications, and patient demographics and associated injuries were assessed.

Methods: All patients with the diagnosis of FDI of the thoracic spine from T1 to T10 that were operatively managed with TPS were retrospectively identified over a 27-month period from February 2003 to April 2005. Evaluation for kyphosis correction, deformity progression, and instrumentation failure included the preoperative, initial postoperative, and most recent upright radiographs. Progression was defined as a greater than 5° increase in Cobb angle. Complications were assessed.

Results: Of the 18 eligible patients, 15 (83%) had adequate follow-up with an average final follow-up of 16.1 months (range, 6-29 months). Average age at surgery was 35.9 years. Six of those patients (40%) had a complete neurologic injury. The most common associated injuries were head and abdomen. The average number of instrumented levels was 6.8. A significant (P <0.001) correction of deformity from a mean preoperative focal kyphosis of 19.60° to a postoperative mean of 5.73° was achieved. The average progression of focal kyphosis was 2.27°, which was not significant (P = 0.128). The maximum measured progression was 4°. There were no instrumentation failures or intraoperative complications. Postoperative complications (13.3%) included an early superficial wound infection and a late removal of implants.

Conclusion/Significance: This is one of the largest reports of posterior-only TPS treatment for thoracic spine FDIs in the English literature, to the best of our knowledge. Previous reports have documented how difficult it is to maintain the corrected focal kyphosis. In our series TPS was able to correct the traumatic deformity and maintain the focal kyphosis without progression or failure with a relatively low complication rate. These data suggest that TPS is an effective treatment option for thoracic spine FDIs.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.