Evaluation of the Results of Surgical Management of Unstable Thoracic Spine by Pedicle Screw and Rod

Background: Surgical management of unstable thoracic spine pathology is technically challenging due to narrow pedicles, overlapping laminae, rib cage constraints, and proximity to the spinal cord and major vessels. This study aimed to evaluate the neurological, functional, and pain outcomes following posterior thoracic spine stabilization in patients. Methods: This study was conducted from July 2022 to May 2024 at the Department of Orthopaedic, Bangladesh Medical University, including 57 patients with unstable thoracic spine pathology treated with posterior decompression and pedicle screw-rod fixation. Clinical, radiological, and functional outcomes were assessed pre- and postoperatively. Neurological status, bowel/bladder function, motor and sensory recovery, pain, and ambulatory ability were recorded. Overall outcomes were classified using modified Macnab criteria. Follow-up was conducted at 1, 3, 6, and 12 months. Results: The mean age was 39.6 ± 15.8 years, with 56.14% females. Preoperatively, 77.19% of patients had bowel/bladder dysfunction, which improved to 3.51% postoperatively. Full motor recovery occurred in 73.68% of patients and partial recovery in 26.32%. Sensory function fully recovered in 71.93% and partially in 22.81%. Perioperative complications included dural tears (12.28%) and hemorrhage (15.79%), while postoperative donor-site pain and residual pain were reported in 10.53% and 8.77%, respectively. Before surgery, 77.19% of patients were unable to stand or walk; postoperatively, 56.14% walked with support and 43.86% independently. Pain decreased from 94.74% preoperatively to 15.79% postoperatively. Overall, 78.9% of patients achieved a satisfactory outcome (excellent 64.91%, good 14%). Conclusion: Posterior thoracic spine stabilization with pedicle screw and rod fixation is a safe and effective method for managing unstable thoracic spine pathology. Surgery resulted in significant improvements in neurological function, ambulation, and pain relief, with an acceptable complication rate.