Comparison of short-time clinical efficacy of percutaneous and open pedicle screw fixation for type A1-A3 thoracolumbar fractures

Abstract

Objective To investigate the clinical efficacy of short segment fixation with percutaneous pedicle screws or traditional open surgery for the type A1-A3 thoracolumbar compression fracture. Methods A retrospective case control study was conducted on the clinical data of 64 patients with thoracolumbar compression fracture admitted to Shanxi Dayi Hospital between January 2012 and February 2017. There were 44 males and 20 females, aged 21-65 years [(45.4±11.1)years]. There was one patient with injured segment at T11, 29 at T12, 27 at L1 and seven at L2. According to AO typing, there were 39 patients classified as Type A1, two as Type A2 and 23 as Type A3. The patients were divided into minimally invasive surgery group (n=37) and open surgery group (n=27). Minimally invasive surgery group was treated with minimally invasive percutaneous pedicle screw fixation and open reduction. The open surgery group was treated with traditional open pedicle screw short segment fixation and open reduction. The operation time, intraoperative blood loss, total hospitalization time, postoperative hospitalization time, visual analogue scale (VAS) before and after operation, local kyphosis of the fractured vertebra, segmental kyphosis and complications in two groups were recorded. Results All patients were followed up for 12-29 months, with an average of 13.2 months. Between the minimally invasive surgery group and open surgery group, no significant difference was found in the operation time [(106.4±37.3)minutes vs.(131.3±33.6)minutes](P>0.05), and significant differences were found in intraoperative blood loss [(71.2±34.9)ml vs.(409.3±267.5)ml], total hospitalization time [(11.7±7.2)days vs. (21.6±12.8)days] and postoperative hospitalization time [(8.1±7.4)days vs. (16.6±10.6)days] (P 0.05), but significant difference was found in VAS immediately after operation between the two groups (P 0.05). In the minimally invasive surgery group, the segmental kyphosis Cobb angle was (16.1±9.1)° before operation, (3.0±1.8)° immediately after operation, and (5.9±1.8)° at final follow-up. In the open surgery group, the segmental kyphosis Cobb angle was (15.2±12.0)° before operation, (3.1±1.4)° immediately after operation, and (5.6±2.1)° at final follow-up. The segmental kyphosis Cobb angle immediately after operation and at final follow-up were significantly decreased within the two groups compared with the preoperative Cobb angle (P 0.05). No spinal cord injuries because of pedicle screws were observed after operation in either group. In the open surgery group, there was one patient with wound infection who recovered after dressing change, and no infection case was found in the minimally invasive surgery group. Conclusion For type A1-A3 thoracolumbar compression fractures, both the minimally invasive posterior pedicle screw fixation and the traditional open pedicle screw fixation can achieve satisfactory near-term results, and the former is better in intraoperative blood loss, immediate relief of pain after operation and shorter hospital stay than the latter. Key words: Spinal fractures; Fracture fixation, internal; Pedicle screws