Abstract
Background: The purpose of this study was to evaluate the effectiveness of minimally invasive posterior mono-axial pedicle screws fixation in the treatment of thoracolumbar burst fractures. Methods: In the present study, we analyzed 98 patients retrospectively who had thoracolumbar burst fractures without a neurological deficit. Patients were divided into two groups: mono-axial pedicle screw fixation group (n = 52) and poly-axial pedicle screw fixation group (n = 46). We collected clinical data (visual analog scale (VAS) score for back pain) and included radiographic measurements. Results: Sagittal index was significantly improved at postop and last follow-up in the mono group and the poly group. The mono group was better for reducing and maintaining anterior vertebral height. For the mono group, the mean postoperative regional kyphosis correction rate was 62.31%, and correction loss was 14.18% in late follow-up. For the poly group, the mean postoperative regional kyphosis correction rate was 52.17%, and correction loss was 33.42% in late follow-up. The mono-axial pedicle screw group had a good correction rate and reduced the risks of correction loss. The mean VAS scores for back pain improved by 2.4/2.5 and 3.8/4.2 for the mono and poly groups, respectively. There was no significant difference between groups. Conclusions: The mono-axial pedicle screw fixation was better for reducing and maintaining anterior vertebral height and regional kyphosis. Therefore, the mono-axial pedicle screw is a better optional instrumentation to treat thoracolumbar vertebral fractures.
Highlights
The most common spinal fractures have been reported to be in the thoracolumbar region [1] because it is in the transition zone between the rigid thoracic kyphosis and more flexible lumbar lordosis [2]
Poly-axial pedicle screws were mainly used in the early study period and in the less severe fractures
Mono-axial pedicle screws were frequently used in order to achieve better fracture reduction
Summary
Conservative treatment is usually the method of choice if there is little kyphotic deformity, no neurological deficit or no unstable posterior vertebral column [3,4,5]. In unstable thoracolumbar burst fractures, operative stabilization is preferred [6,7,8,9]. An anterior or posterior approach, or combined approaches are used for the treatment of thoracolumbar burst fractures [13,14]. Spine surgeons often prefer the posterior approach because of its easy application, reduction of intraoperative bleeding and low degree of invasiveness [11]. The purpose of this study was to evaluate the effectiveness of minimally invasive posterior mono-axial pedicle screws fixation in the treatment of thoracolumbar burst fractures
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