Open vs. Percutaneous Pedicle Screw Insertion for Thoracolumbar Traumatic A3 and A4 AO Fractures - 18-Months Follow-Up

Abstract

Purpose To compare the efficacy and safety of the percutaneous screw fixation (PSF) and the open pedicle screw fixation (OPSF) on thoracolumbar (TL) fracture. Methods Sixty-four adult patients with TL vertebral fractures who underwent open or percutaneous posterior short-segment transpedicular screw fixation between January of 2013 and September of 2015 were retrospectively reviewed. All patients underwent clinical, radiological and quality of life follow-up for at least 18 months. Results There was no significant difference in age, gender, time between injury and surgery, and preoperative percentage of anterior column height, preoperative sagittal regional Cobb angle, or kyphotic angle of fractured vertebra between these two groups (p > 0.05). There was significantly less intraoperative blood loss in the PSF (87.6 ± 24.6 mL) than in the OPSF group (271.4 ± 142.6 mL) (p < 0.05). The mean surgery time was 62 minutes (range 42–130 minutes) for open and 58 minutes (range 35 to 128 minutes) for percutaneous screw fixation. The surgery time was shorter in the PSF group, but with no statistical significance (p > 0.05). The mean Oswestry disability index (ODI) scores after 18-months were 23.12 ± 8.2 for the PSF and 24.12 ± 9.2 for the OPSF group, without any statistical significance (p > 0.05). Conclusion Both open and percutaneous screw fixations are safe and effective. The percutaneous techniques significantly reduced the intraoperative blood loss compared with the open techniques.