O2176 CORRELATIVE ANALYSIS OF THE RESULTS OF SURGICAL TREATMENT OF THORACOLUMBAR FRACTURES WITH TEXAS RITE HOSPITAL INSTRUMENTATION. HOOKS VERSUS PEDICLE SCREWS

Abstract

Aims: To study the efþcacy of Texas Scottish Rite Hospital transpedicular screws versus laminar hooks in lumbar spine. Methods: 40 patients with unstable thoracolumbar fractures and spinal canal encroachment were randomly sampled into two groups: 20 patients received hooks in Òclaw conþgurationÒ in thoracic and lumbar spine (Group A), and 20 patients hooks in thoracic and transpedicular screws in the lumbar spine (Group B). Gardner kyphotic deformity; anterior vertebral body height (AVBH); Posterior vertebral body height (PVBH); and Spinal canal encroachment (SCE) were measured in roentgenograms and CT-scan. Results: All patients were followed for 52 months, (range, 42–71 months) postoperatively. Gardner angle was corrected at 45% and 48% with a loss of correction of 1.5û and 1û for Group A and B respectively. AVBH was corrected at 16% and 33% in Group A and B with loss of correction of 11% only in group A. PVBH was restored only in Group B at 3%, while the loss of correction was 4% and 1% for group A and B respectively. SCE was postoperatively decreased at 19% and 32% in group A and B respectively. On the latest evaluation there was an increase of SCE at 9% in group A, while it was furthermore decreased at 10.5% in-group B. All patients with incomplete neurologic lesions in-group A and B were postoperatively improved at 1.1 degrees and 1.7 degrees respectively. There was no screw failure, while there was two hook dislodgements in the thoracic spine (one in each group). There was neither pseudarthrosis nor neurologic deterioration in this series. Conclusions: The use of pedicle screws in the lumbar spine for stabilization of thoracolumbar injuries offers better correction of posttraumatic kyphotic deformity, restores and maintains better than hooks anterior and posterior vertebral body height of the fractured vertebra without loss of correction, and safeguard continuous remodeling of spinal canal resulting in increasing spinal canal clearance with time lapsed from operation.