TRANSPEDICULAR FIXATION WITH ZIELKE INSTRUMENTATION IN THE TREATMENT OF THORACOLUMBAR AND LUMBAR INJURIES

Study Design. Sixty-five patients who underwent transpedicular fixatio n for thoracolumbar and lumbar injuries were studied for type of injur y, the severity of paralysis, the degree of postoperative correction, and instrumentation failures. Objectives. To evaluate the surgical app roaches and the selection of instrumentation to determine indications for using the transpedicular fixation procedure. Summary of Background Data. Various transpedicular fixation devices have been used for diff erent type of injuries, and satisfactory postoperative results were no t obtained in some studies. Methods. Forty patients had burst fracture s, 19 had fracture dislocations, and six had chance-type fractures. An anterior decompression procedure was used for most cases of burst fra cture and some cases of fracture dislocation where anterior compressio n factors were present. The Zielke or modified Zielke system was used as an internal fixator for posterior segmental fixation. Results. No p atient had neurologic deterioration after surgery. Twenty of 28 patien ts with incomplete lesions improved postoperatively according to Frank el grades. The instrumentation failed in only one patient, in whom a n onunion developed. Conclusion. With transpedicular fixation, it is pos sible to provide solid internal fixation that is circumscribed to the injured vertebral segments. The elasticity of the Zielke rod makes it an excellent transpedicular fixation device because it is easily attac hed and reduction is easily performed. Anterior decompression with fus ion needs to be used with transpedicular fixation in the treatment of injuries (especially burst fractures).