Transpedicular screw-rod fixation in the treatment of unstable lower thoracic and lumbar fractures

A total of 41 consecutive cases of unstable lumbar and lower thoracic spine fractures or fracture dislocations were treated by the authors at the Soroka Medical Center, Beer-Sheva, Israel between 1988 and 1992, using the Dick Internal Fixator, for reduction of the deformity and fixation. Twenty-nine of the 41 cases, 19 males and 10 females with an average age was 30.5 years, had a mean postoperative follow-up of 24 months Their injuries, 44 fractured vertebrae, were due to road traffic accident in 11 instances, falls from a height in 11 (of whom 4 were suicide attempts), work accidents in 6, and gunshot wound in 1. Among the vertebral injuries, 3 patients sustained a two-column injury and 26 a three-column injury, according to the Denis classification. Reduction of the kyphotic deformity was achieved, obtaining the proper height of the injured vertebra or reduction of the fracture-dislocation, and assuring a proper fixation, using a bilateral transpedicular screw-rod fixation system. Neurological improvement occurred in 9 cases of the 18 who had neurological deficit at admission. According to Frankel's criteria, these patients had an average of 1.125 Frankel's grade improvement; three of these patients recovered completely. There were no operative or postoperative deaths. Major complications included one case of major postoperative gastrointestinal bleeding, one case of pulmonary emboli, and two cases of deep wound infections. This study recommends the use of the Dick Internal Fixator for the correction of major spinal deformities due to its greater structural rigidity and greater availability of bone surfaces for fusion.