Impact of Posterior Decompression and Pedicle Screw-Rod Fixation on Bowel-Bladder Function, Ambulation, and Pain in Unstable Thoracic Spine Pathology

Background: Unstable thoracic spine pathology from trauma, infection, tumor, or degenerative collapse can cause neurological deficits, bowel-bladder dysfunction, loss of ambulation, and severe pain, significantly affecting quality of life. Posterior decompression with pedicle screw-rod fixation restores stability and neurological function. This study aims to evaluate the Impact of Posterior Decompression and Pedicle Screw-Rod Fixation on Bowel-Bladder Function, Ambulation, and Pain in Unstable Thoracic Spine Pathology. Methods: This study was conducted from July 2021 to May 2023 at the Department of Orthopaedic, Bangladesh Medical University, including 57 patients with unstable thoracic spine pathology undergoing posterior decompression and pedicle screw-rod fixation. Baseline data on demographics, neurological status, pain, and mobility were collected. Postoperative follow-up was conducted at 1, 3, 6, and 12 months. Functional outcomes were assessed using modified Macnab criteria. Changes in bowel-bladder function, ambulation, and pain were analysed using paired proportion tests, with absolute risk differences and 95% confidence intervals calculated. Results: The cohort had a mean age of 39.6 ± 15.8 years, with 56.1% females. Preoperatively, bowel-bladder dysfunction was present in 77.2%, diminished motor function in 75.4%, impaired sensory status in 91.2%, inability to ambulate in 77.2%, and pain in 94.7%. Perioperative complications included dural tear (12.3%) and haemorrhage (15.8%), while postoperative complications included donor site pain (10.5%) and residual pain (8.8%). At 12 months, bowel-bladder dysfunction decreased to 3.5% (absolute risk reduction 73.7%, 95% CI 61.8-85.6, p < 0.001), pain to 15.8% (78.9%, 95% CI 67.8-90.0, p < 0.001), inability to ambulate to 0% (77.2%, 95% CI 66.3-88.1, p < 0.001), and satisfactory functional outcomes (Macnab excellent + good) increased from 0% to 78.9% (95% CI 68.4-89.5, p < 0.001). Conclusion: Posterior decompression with pedicle screw-rod fixation effectively restores autonomic function, mobility, and reduces pain in unstable thoracic spine pathology.