Prospective study: early complications and short term neurologic outcome following posterior thoracolumbar pedicle screw fixations at two Ethiopian teaching hospitals, Addis Ababa, Ethiopia.

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Date

2020-12

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Addis Abeba University

Abstract

BACKGROUND: Pedicle screw fixation is a well-known and increasingly performed technique to achieve fixation and fusion especially in thoracolumbar region. This technique is used for variety of indications. Despite technical advances in screw fixations complications can happen intraoperative or postoperative, and still PSF is associated with a risk of complication. OBJECTIVE: To assess early complicat ions and short term neurologic outcome following thoracolumbar pedicle screw fixat ions at two Ethiopian teaching hospitals. METHODS: One year hospital-based prospective descriptive study was conducted on 68 patients that underwent posterior thoracolumbar pedicle screw fixation and fusion at ALERT and MCM hospitals from September 2019 to August 2020. To determine the existence and level of association between independent and dependent variables bivariate Pearson´s correlation analysis was done, and multiple regression analysis was also done to identify the existence of statistically significant association between independent variables and neurologic status at 3 rd month. RESULTS: 52 male and 16 female patients were included. The mean age was 31.79. Indications for hardware placement were trauma - 82.4 % (56 patients), degenerative and spondylolisthesis - 11.8% (8 patients), tumour - 2.9% (2 patients), infection - 1.5 % (1 patient), and one patient L2 screw fracture (previously PSF was done). A total of 351 screws were inserted. Most screws (76 screws - 21.7%) were inserted at the level of T12. Determined accuracy rate screws inserted was 88.0%, with screw malposition rate of 12%. Highest number of breech was found at the level of T12 - 9 breeches. Medial breech was the commonest (47.6 % of breeches, 20 screws), followed by anterior breech (38.09 %, 16 screws). Intra-op complications happened for 16 patients (23.5%), 8 were intra-op CSF leak, 7 - intra-op pedicle fracture, and one nerve root injury. Early post-op complications that happened during hospital stay were one deep SSI, two UTI, three HAI, and five bed sores. Complications after discharge were two superficial SSI, two UTI, seven additional bedsores. Revision surgery was done for two patients (2.9%). On neurologic evaluation at third month, 72.9% of patient (35 patients) were neurologically the same, 14.6% (7 patients) had some improvement, and 12.5% (6 patients) had significant improvement. The majority of patients 87.9% did not receive physiotherapy. With 95% CI, only the presence of associated other site of injury (P=0.02) and lower extremity power status (P=0.02) have moderate correlation with the development of in-patient complications with r value of .404 and .362 respectively. On multiple regression analysis pre-op sensory level has a negative and significant effect on neurologic outcome at third month (standardized beta = . -1.690). CONCLUSIONS: Trauma was the commonest indication for fixation. Based on our result finding posterior thoracolumbar pedicle screw fixations and fusions with can be done with acceptable complication rate and good recovery considering the limited resources. Since our follow-up period was only 3 month, we recommend further follow-up study of these patients for assessing late instrument related complications.

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Keywords

Thoracolumbar, pedicle screw fixations, intraoperative, postoperative

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