A comparison of three different surgery approaches and methods for neurologically intact thoracolumbar fractures: a retrospective study

Chao Zhu,Jian Yin,Bin Wang,Xin Hui Liu

doi:10.1186/s13018-021-02459-6

Abstract

ObjectivesThe purpose of this study was to evaluate and compare the feasibility, safety, and efficacy of conventional open pedicle screw fixation (COPSF), percutaneous pedicle screw fixation (PPSF), and paraspinal posterior open approach pedicle screw fixation (POPSF) for treating neurologically intact thoracolumbar fractures.MethodsWe retrospectively reviewed 108 patients who were posteriorly stabilized without graft fusion. Among them, 36 patients underwent COPSF, 38 patients underwent PPSF, and 34 patients underwent POPSF. The clinical outcomes, relative operation indexes, and radiological findings were assessed and compared among the 3 groups.ResultsAll of the patients were followed up for a mean time of 20 months. The PPSF group and POPSF group had shorter operation times, lower amounts of intraoperative blood loss, and shorter postoperative hospital stays than the COPSF group (P < 0.05). The radiation times and hospitalization costs were highest in the PPSF group (P < 0.05). Every group exhibited significant improvements in the Cobb angle (CA) and the vertebral body angle (VBA) correction (all P < 0.05). The COPSF group and the POPSF group had better improvements than the PPSF group at 3 days postoperation and the POPSF group had the best improvements in the last follow-up (P < 0.05).ConclusionBoth PPSF and POPSF achieved similar effects as COPSF while also resulting in lower incidences of injury. PPSF is more advantageous in the early rehabilitation time period, compared with COPSF, but POPSF is a better option when considering the long-term effects, the costs of treatment, and the radiation times.

Highlights

Most spinal fractures occur in the thoracolumbar segment, which is biomechanically weak against external injury [1, 2]
These patients were divided into 3 groups based on the surgical approach and method in this study: a COPSF group (36 patients who received conventional open approach pedicle screw fixation), a PPSF group (38 patients who underwent percutaneous pedicle screw fixation), and a POPSF group (34 patients who were treated with paraspinal posterior open approach pedicle screw fixation)
visual analog scores (VAS) and hospital stays were significantly lower in the PPSF group than those in the POPSF group. These findings suggested that both the PPSF group and the POPSF group are classified as minimally invasive approaches, percutaneous surgery is more advantageous in early recovery than paraspinal approach surgery

Summary

Introduction

Most spinal fractures occur in the thoracolumbar segment, which is biomechanically weak against external injury [1, 2]. In 1968, Wiltse et al first reported the paraspinal posterior open approach pedicle screw fixation (POPSF) method as a minimally invasive approach for treating lumbar spinal fractures [9]. A number of clinical studies have compared PPSF to conventional open approach pedicle screw fixation (COPSF) [13,14,15]. Some clinical studies have compared the paraspinal posterior open approach pedicle screw fixation (POPSF) to COPSF in the treatment of thoracolumbar fractures [16, 17]. We compared related data from patients with neurologically intact thoracolumbar fractures who had undergone short-segment pedicle fixation, either by the conventional posterior open approach or by the minimally invasive approach containing PPSF and POPSF. The purpose of this study was to provide a scientific basis for the suitable choice of the surgical approaches for patients with thoracolumbar fractures

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