RETROSPECTIVE STUDY OF POSTERIOR DORSOLUMBAR FIXATION IN BAGHDAD: A CLINICAL STUDY OF 100 PATIENTS

Yasir M H Hamandi, Ali mohammad khalil

Abstract


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


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