Publication:

Predictors of junctional failure following pedicle fixation in thoracolumbar spine in traumatic spinal cord injury at the National Orthopaedic Hospital Dala Kano, Nigeria

Background Junctional failure (JF) is a known complication after posterior pedicle screw fixation for traumatic thoracolumbar fractures, yet its predictors in low‑resource settings remain undefined. This study aimed to identify risk factors for JF following pedicle fixation in patients with traumatic spinal cord injury.

Methods A retrospective cohort study of 172 patients who underwent posterior pedicle screw fixation for acute traumatic thoracolumbar fractures (T10–L3) between January 2020 and December 2025 at the National Orthopaedic Hospital Dala, Kano. JF was defined as proximal or distal junctional kyphosis >10° or implant failure within 24 months. Multivariate logistic regression identified independent predictors.

Results Mean age was 39.4±13.8 years; 68% male. JF occurred in 31 patients (18.0%) at mean 11.2±4.5 months post‑surgery. Independent predictors were: age >50 years (OR 3.2, 95% CI 1.6–6.4), fusion length ≥4 levels (OR 2.8, 95% CI 1.4–5.6), preoperative local kyphosis >25° (OR 2.5, 95% CI 1.2–5.2), screw density <0.8 (OR 2.1, 95% CI 1.0–4.3) and osteoporosis (OR 3.0, 95% CI 1.5–6.0). Revision surgery was required in 14 patients (45.2% of JF). Patients with JF had worse functional outcomes (ODI 48.2 vs. 32.5, p<0.001).

Conclusions Junctional failure after thoracolumbar pedicle fixation is common (18%) in this Nigerian cohort. Older age, longer fusion, inadequate screw density, severe preoperative kyphosis and osteoporosis are independent predictors. Strategies to reduce JF include optimising bone health, limiting fusion length and achieving high screw density.