Yasir M H Hamandi, Ali mohammad khalil


Background: Spondylolisthesis describes a condition of a forward slippage of one vertebra over another, which may or may not be associated with demonstrable instability. Spinal fixation is a neurosurgical procedure in which two or more vertebrae are anchored to each other through a synthetic "vertebral fixation device"

Objective: To determine the demographic distribution of different patient factors and the most commonly vertebra undergo fixation in the thoracolumbar instrumentation.

Patients and Methods: one hundred patients were evaluated during the period of this study in a retrospective manner from January 2013 to January 2015 in four hospitals in Baghdad (Neurosurgical Teaching Hospital, Neuroscience hospital, Al-Kahdymia Teaching Hospital, Medical City\Ghazy AL-Hariri Hospital). The patients' data regarding the etiology of instability, mechanism of injury for trauma patients, gender, age, segments undergoing instrumentation were identified.

Results: The study revealed female predominance over male: female ratio of 1:2.7, the age distribution was highest from 3rd to 7th decades of life, the etiology of instability was either degenerative or traumatic, the degenerative instability was 65% while traumatic cases was 35%. The neurological status of the patients was assessed by neurological examination and revealed 75% with incomplete deficit and 25% with complete neurological deficit, the most common pathologically involved vertebra was the L4, the most common vertebrae used in fixation were the L4 and L5 levels, the most common type of fixation used was the short segment fixation.

Conclusion: Posterior spinal fixation with pedicle screws and rods system is an effective and safe method in maintaining the stability of spine. The intraoperative imaging is important in maintaining safe trajectory of screws. Short segment fixation using the posterior approach with pedicle screw-rod fixation devices achieve good stabilization. The ideal candidates for undergoing posterior spinal fixation are patients with unstable fractures & incomplete neurological deficit.

Recommendation: The use of intraoperative neuro-monitoring, use of navigation system,  use of fluoroscopy and the O-arm  in spinal fixation surgery. Bone fusion is recommended for each patient.

Keywords: Thoracolumbar spine, spondylolisthesis, pedicle screw fixation


Boos N, Aebi M: Spinal disorders fundamentals of diagnosis and treatment 2008. Spinal Instrumentation 3: 67-86.

Shaffrey I, Sonntag H, Dennis G: Youmans neurological surgery 2012 6th edition. Posterior Thoracic Instrumentation 301: 3061-3067.

Benzel C: Spine Surgery 2012 3rd edition. History of Spinal Instrumentation: The Modern Era 2: 21-29.

Bono CM, Lee CK: Critical analysis of trends in fusion for degenerative disc disease over the past 20 years: influence of technique on fusion rate and clinical outcome 2004. Spine 29: 455–463.

Lagrone MO, Bradford DS, Moe JH: Treatment of symptomatic flatback after spinal fusion 1988. J Bone Joint Surg. 70: 569–580.

Esses ST, Bednar DA: The spinal pedicle screw: techniques and systems 1989; 18: 676–682.

Zucherman JF, Hsu KY, Hartjen CA: A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results 2005. Spine 30: 1351–1358.

Shaffrey I, Sonntag H, Dennis G: Youmans neurological surgery 2012 6th edition. Posterior Lumbar Instrumentation 303: 3075-3082.

Gertzbein SD, Robbins SE: Accuracy of pedicular screw placement in vivo. Spine 1990; 15: 11-14.

Chung KJ et al: Ideal entry point for the thoracic pedicle screw during the free hand technique. Int Orthop 2008; 32: 657-662.

Abdulameer J. Al-Kafaji et al: Pedicle Screw Placement versus Classic Surgery in Lumbothoracic Spine Disorder . Iraqi journal of medical scince 2014 :230-237 .

Muralidhar B.M. et al: Management of unstable thoracolumbar spinal fractures by pedicle screws and rod fixation. Journal of Clinical and Diagnostic Research. 2014 Feb, Vol-8(2):121-123.

Shailendra et al: Surgical outcome of posterior short segment trans-pedicle screw fixation for thoracolumbar fractures. Journal of orthopedics 10 (2013) 162-167.

Alexander R. et al: Pedicle-Screw Fixation in the Lumbar Spine. Journal of the American Academy of Orthopedic Surgeons 1995; 3:263-274.

Alp Ozgun BOrcek et al: Accuracy of Pedicle Screw Placement in Thoracolumbar Spine with Conventional Open Technique. Turk Neurosurg 2014, Vol: 24, No: 3, 398-402.

Kashif Mahmood Khan et al: Posterior Spinal Fixation with Pedicle Screws and Rods System in Thoracolumbar Spinal Fractures. Journal of the College of Physicians and Surgeons Pakistan 2012, Vol. 22 (12): 778-782.

Parker SL et al: Accuracy of free-hand pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws. Neurosurgery 2011; 68: 170-178.

Faraj et al: Early complications of spinal pedicle screw. Euro Spine J 1997 (6): 324-326.

Sanford HD et al: Complications of lumbar spinal fusion with transpedicular instrumentation 1992. Spine 17: 183-189.

Ohlin A. et al: Complications after transpedicular stabilization of the spine 1994. Spine 19: 2774-2779.

Roop Singh et al: Outcome of Pedicle Screw Fixation and Monosegmental Fusion in Patients with Fresh Thoracolumbar Fractures. Asian Spine J 2014; 8(3):298-308.

Full Text: FULL TEXT


  • There are currently no refbacks.