The successful short-term treatment of flexion-distraction injuries of the thoracic spine using posterior-only pedicle screw instrumentation.

STUDY DESIGN: In this retrospective study, the results of treating unstable flexion-distraction injuries (FDI) of the thoracic spine with posterior-only thoracic pedicle screw (P/TPS) instrumentation were investigated. OBJECTIVE: The objective was to determine the ability of P/TPS to correct and maintain the focal kyphosis of the injured spine. Clinical outcome and complications of the surgical procedure were also a focus of the study. SUMMARY OF BACKGROUND DATA: The treatment of FDI of the thoracic spine remains controversial. There continues to be difficulty in maintaining the corrected kyphosis angle regardless of the surgical approach used. METHODS: Eighteen patients with FDI of thoracic spine who underwent P/TPS were identified. The initial and corrected focal kyphosis was evaluated radiographically. Failure of treatment was defined as a >5-degree progression of corrected kyphosis from initial to latest follow-up. Clinical evaluation included complication rate, Injury Severity Score, and Frankel grade. RESULTS: Of the 18 eligible patients, 15 (83%) had adequate follow-up for evaluation. The mean length of follow-up care was 16.1 months. The average Injury Severity Score was 23. The average number of instrumented levels was 6.8. The focal kyphosis of the injury was reduced from a mean of 19.60 to 5.73 degrees (P<0.001), with an average progression of only 2.27 degrees (P=0.128) at final follow-up. Complications were limited to wound infections and occurred in 2 study participants. Neurologic status returned to normal in all patients with incomplete cord injuries. CONCLUSIONS: FDI of the thoracic spine may be amendable to a uniform surgical approach with P/TPS. This procedure carried a relatively low complication rate and allowed for reduction and restoration of the posterior tension band with a biomechanically rigid construct.