Effect of angular correction during posterior instrumentation of spinal fractures on postoperative outcomes and quality of life

Abstract

BACKGROUND: Posterior instrumentation using pedicle screws and rods is the most commonly used technique for the treatment of thoracolumbar fractures of the spine. The procedure aims to restore the neurologic and biomechanical functions of the spine and allows for early mobilization and rapid reintegration into society. It is unclear whether the magnitude of correction has an effect on postoperative outcomes. OBJECTIVE: We aimed to determine whether the magnitude of sagittal angular correction during posterior instrumentation of the spine had an effect on postoperative quality of life, pain and function outcomes as measured using the EQ5D-3L and the Core Outcome Measures Index (COMI) instruments. We also aimed to quantify the correlation between EQ5D-3L and COMI scores. METHODS: We analyzed the pre- and postoperative radiographs of 52 patients who underwent percutaneous pedicle screw placement for thoracolumbar fractures, as well as their self-reported EQ5D-3L and COMI quality of life, pain and functional outcome scores. Regression models were constructed to estimate the effect that the magnitude of Cobb angle correction had on postoperative outcomes. We also estimated the correlation between EQ5D-3L and COMI scores. RESULTS: The median EQ5D-3L TTO score was 0.9 (range, -0.1 to 1). The median COMI score was 3.1 (range, 0 to 10). There was no significant effect of the magnitude of correction on EQ5d-3L TTO scores (p= 0.3379; R= 0.36) or on COMI scores (p= 0.3379; R= 0.15). Age and bone mineral density were not found to be significant predictors of outcome (p= 0.05). There was a strong correlation between the EQ5D-3L TTO and COMI scores (r=-0.62). CONCLUSION: The magnitude of Cobb angle correction during pedicle screw instrumentation of thoracolumbar fractures did not influence quality of life, pain or function outcomes. There was good correlation between EQ5D-3L TTO scores and COMI scores.