Minimally Invasive Decompression and Intracorporeal Bone Grafting Combined with Temporary Percutaneous Short-Segment Pedicle Screw Fixation for Treatment of Thoracolumbar Burst Fracture with Neurological Deficits

Abstract

We evaluated the clinical and radiographic outcomes of patients with thoracolumbar burst fractures and neurological deficits treated with minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment stabilization. Patients with thoracolumbar burst fractures and neurological deficits underwent minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment stabilization. Instrumentation was removed approximately 1 year after vertebral fracture union. The clinical and radiographic outcomes were analyzed. The mean operative duration and intraoperative bleeding volume were 135 ± 63 minutes and 120 ± 200 mL, respectively. The average American Spinal Injury Association impairment scale scores had significantly improved at the final follow-up examination. The visual analog scale score had decreased from 7.8 ± 1.1 preoperatively to <2.9 ± 1.3 (P < 0.05) at 1 week postoperatively. The Oswestry disability index had decreased from 86.1 ± 8.8 preoperatively to 15.9 ± 6.4 (P < 0.05) at 1 year postoperatively. The canal stenosis index had improved from 43.4% ± 12.0% to 93.8% ± 4.8% (P < 0.05). The sagittal Cobb angle had been corrected from 17.8° ± 7.5° to 4.0° ± 1.9° (P < 0.05) and remained at 4.9° ± 2.0° (P > 0.05) at 1 year postoperatively. The sagittal index had been corrected from 16.6° ± 6.1° to 0.3° ± 4.6° (P < 0.05) and remained at 1.5°+ 4.5° (P > 0.05) at 1 year postoperatively. The anterior vertebral height had increased from 49.3% ± 11.1% to 97.6% ± 6.5% (P < 0.05) and remained at 95.7% ± 6.0% (P > 0.05) at 1 year postoperatively. After implant removal, the total kyphosis correction losses were 1.5° ± 0.8° for the Cobb angle, 2.0° ± 1.1° for the sagittal index, and 3.4% ± 2.1% for the anterior vertebral height. One pullout screw and one broken rod were found in 1 patient each. Minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment fixation yielded satisfactory results in decompression and immediate kyphosis correction. Additionally, this procedure resulted in maintenance of the vertebral height and prevented late correction loss after implant removal.