Percutaneous pedicle screw insertion for treatment of lumbar spine compression fractures via intersection of facet and center line of transverse process

Abstract

Objective To compare the clinical effect of percutaneous pedicle screw insertion via intersection of facet and center line of transverse process and traditional percutaneous placement method in treatment of lumbar spine compression fractures. Methods A prospective study was performed on 56 patients with lumbar spine compression fractures without neurologic deficits admitted from January to May in 2014. There were 26 males and 30 females, aged from 20 to 47 years (mean, 37.1 years). Adjacent vertebrae above and below the fractured vertebra were instrumented, and each pair of pedicle screws of every instrumented vertebra were instrumented via traditional entry point (Group A) or via intersection of facet and center line of transverse process (Group B) according to the random number table. Preoperative and postoperative anterior vertebral height and Cobb angle were measured, and every pedicle screw was graded according to facet violation grading system. Intraoperative data were compared between the two groups, including time of determining entry point, frequency of fluorescence to determine entry point, patient radiation exposure, doctor radiation exposure and screw length. Visual analogue scale (VAS) and Oswestry disability index (ODI) were documented at postoperative 3 days, 1 month, 3 months, 6 months and 1 year. Patients with persistent back pain were managed by facet block according to the tenderness point, and the rate of persistent back pain and remission rate were compared between the two groups. Results Anterior vertebral height and Cobb angle were significantly improved after operation (P 0.05). Group B presented more level 0 violation and less level 1 and level 2 violation compared to Group A (P 0.05). VAS and ODI at postoperative 3 months were significantly lower than the preoperative indicators (P<0.01). Rate of persistent back pain and remission rate in Group A (47.3%, 79.2%) differed significantly from those in Group B (24.1%, 25.9%)(P<0.05). Conclusions Percutaneous pedicle screw instrumentation is effective in treatment of lumbar spine compression fractures. Choosing the entry point of intersection of facet and center line of transverse process, far away from facet joint, can bring less facet violation and less postoperative back pain. Key words: Lumbar vertebrae; Fracture fixation, internal; Percutaneous pedicle screw