SPINE: fracture management with pedicle screw fixation
22 year old male farmer presented
with history of fall from tree. He came with complaints of severe pain in back
and right foot. There was no neurological deficit and the patient was able to
pass urine with control. There was bruising and tenderness at dorso-lumbar
spine junction. Right foot was swollen and deformed. X rays showed compression
fracture L1 vertebra with reduction in height of vertebra and focal kyphosis.
There were multiple fractures in right foot metatarsals. The patient was
stabilized and thereupon, MRI lumbar spine was done. MRI confirmed fracture
configuration, the posterior wall was intact and minimal canal compromise was
there. The patient was taken to Operation Theater. In prone position on spine
frame, injured level was exposed dorsally. One level above and below the
injured level were marked in IITV. The entry points of pedicle screws were
exposed without injuring the facet capsule. Pedicle screws were inserted in
pedicle of D 12 and L2 vertebra. There were connected with rods bent in
lordosis. Lordosis was further created with OT table positioning. The rods were
connected in screws and distraction was done to achieve height of collapsed
vertebra. Wound was washed and closed. Post operatively neurology was found to
be intact. The patient was made to sit and mobilized in wheel chair 2 days
after surgery wearing Taylor’s brace. Sutures were removed on 12thpost-op day. Taylors brace was continued for 2 months.