Evaluating Long-Term Instrumentation Stability in Patients of Thoracolumbar Injuries
Abstract
Background: Posterior pedicle screw instrumentation is the standard of care for unstable thoracolumbar spine injuries. While short-term efficacy is well-established, data on the long-term (>5 years) structural integrity of the instrumentation and its correlation with clinical outcomes remain limited. Methods: We conducted a retrospective cohort study at a single tertiary trauma center. A total of 121 patients with single-level thoracolumbar burst fractures (AO Spine Type A3/A4) treated with posterior-only pedicle screw fixation between January 2008 and December 2015 were included. The mean follow-up period was 8.2 ± 2.1 years (range, 5.5-12.0 years). Radiological evaluation included measurement of the local kyphotic Cobb angle and anterior vertebral body height (AVBH) percentage at pre-operative, immediate post-operative, and final follow-up time points. Instrumentation-related complications, including screw loosening, screw breakage, and rod fracture, were recorded. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for back pain and the Oswestry Disability Index (ODI). Results: The mean local kyphotic Cobb angle was significantly corrected from 21.5° ° 5.4° pre-operatively to 4.8° ± 2.1° post-operatively (p < 0.001). At the final follow-up, a minor but statistically significant loss of correction was observed, with a mean Cobb angle of 7.1° ± 2.8° (p < 0.001 compared to post-operative). Similarly, the AVBH percentage improved from 65.2% ± 10.1% to 92.4% ± 5.5% (p < 0.001) and slightly decreased to 88.9% ± 6.3% at final follow-up (p = 0.002). Instrumentation-related complications occurred in 11 patients (9.1%), including screw loosening (n=8, 6.6%) and rod fracture (n=3, 2.5%). Both VAS and ODI scores showed significant improvement from pre-operative to final follow-up (VAS: 8.1 ± 1.0 to 2.2 ± 1.3, p < 0.001; ODI: 75.4% ± 8.9% to 18.6% ± 10.2%, p < 0.001). Conclusion: Posterior pedicle screw instrumentation provides excellent and durable long-term stability for thoracolumbar burst fractures. Despite a minimal, statistically significant loss of sagittal correction over time, the fixation maintains overall spinal alignment and is associated with sustained, significant improvements in pain and function. The rate of long-term instrumentation failure is relatively low.Keywords:
Thoracolumbar spine, spinal fracture, posterior instrumentation, long-term stability, pedicle screw, loss of correction, clinical outcomesReferences
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