Steffee variable screw placement system in the management of unstable thoracolumbar fractures: a Third World experience.

Twenty consecutive patients with unstable thoracolumbar fractures were taken up for posterior spinal stabilization using the Steffee VSP system at the earliest opportunity. Patients were followed up from 20 to 38 months. 70% patients were operated within 3 weeks of sustaining injury (group 1) while injury-operation interval exceeded 3 weeks in 30% (group II). The average preoperative kyphotic angle was 19.35 degrees which improved to 8.70 degrees, the correction being much more in group I (17.60 degrees to 5.3 degrees) compared to group II (22.90 degrees to 14.40 degrees). The average preoperative vertebral body height was 57.75% which improved to 79.75%, the correction being much more in group I (61.20 to 88.40%) compared to group II (51.40 to 63.70%). No patients deteriorated neurologically while 7 out of 16 patients with neurological deficit showed improvement by one or more Frankel Grade (43.75%). It is concluded that reasonable correction of deformity, fair chance of neurological recovery and significant reduction of recumbency associated complications can be expected even when surgery is delayed.