Outcome of Short Segment Pedicle Screw Fixation with Intermediate Screw in the Treatment of Unstable Thoracolumber Fracture

Background: Unstable thoracolumbar fractures require surgical stabilization to restore spinal alignment, maintain neurological integrity, and prevent progressive kyphotic deformity and mechanical instability. Objective: To evaluate clinical, neurological, and radiological outcomes of short-segment pedicle screw fixation with intermediate screw placement in unstable thoracolumbar fractures. Methods: This prospective observational study was conducted in the Department of Orthopaedic Surgery, Sylhet MAG Osmani Medical College (SOMC), Sylhet, over 2.5 years (January 2023–June 2025). Fifty-four patients with unstable thoracolumbar fractures underwent short-segment pedicle screw fixation with intermediate screw placement. Neurological outcome (ASIA scale), functional outcomes (VAS, ODI, Modified McNab), and radiological outcome (Cobb angle) were analyzed using SPSS-26. Results: Mean patient age was 33.12±10.41 years, with males comprising 74.1%. Fall from height accounted for 70.4% of injuries, and L1 fracture was most common (51.9%). Mean preoperative Cobb angle improved from 23.18±6.94° to 6.12±2.85° postoperatively and 9.04±3.21° at 6-month follow-up (p<0.01). Mean correction loss was 2.92±1.74°. ODI improved from 65.21±12.48 to 18.76±9.12 (p<0.001), while VAS decreased from 58.44±8.63 to 19.11±6.88 (p<0.001). ASIA improvement occurred in 92.6% patients (1-grade: 66.7%, 2-grade: 25.9%). Excellent-to-good Modified McNab outcome was observed in 85.2%. Complication rate was 7.4%, without implant failure. Correlation analysis showed Cobb correction positively correlated with ODI improvement (r=0.41, p=0.002). Conclusion: Intermediate screw augmentation in short-segment fixation provides superior maintenance of kyphotic correction with significant functional improvement and low complication rates in unstable thoracolumbar fractures.