Short-Segment Fixation With Percutaneous Pedicle Screws in the Treatment of Unstable Thoracolumbar Vertebral Body Fractures.

Abstract

Clinical care of patients with unstable thoracolumbar vertebral body fractures may be challenging, especially in the setting of polytrauma patients who require other acute intervention. Compared with the traditional open approach, percutaneous short-segment fixation constructs place less surgical burden on patients regarding operative time and blood loss. Between 2008 and 2012, 32 patients with a mean age of 49 years (range, 19-80 years) underwent percutaneous short-segment fixation at the authors' institution and had a minimum of 6 months of complete clinical and radiographic follow-up. Load-sharing classification scores were determined. Outcomes evaluated included anterior body height, posterior body height, local kyphosis, regional kyphosis, thoracolumbar junctional kyphosis, mean operative time, and total blood loss. Standard binomial and categorical comparative analyses were performed. All load-sharing classification scores were 7 or less, and 11 of the 32 patients were polytrauma patients requiring surgery. No difference was seen between preoperative and late measurements of anterior body height, posterior body height, local kyphosis, regional kyphosis, or thoracolumbar junctional kyphosis. There were no complications, revisions, or anterior corpectomies. Only 2 patients (6%) underwent elective removal of hardware at 1 year. Mean operative time was 43 minutes (range, 33-56 minutes), and mean estimated blood loss was less than 50 mL. Percutaneous short-segment fixation prevented loss of vertebral body height and progression of kyphosis in the treatment of unstable thoracolumbar fractures with load-sharing classification scores of 7 or less. This study shows that these fractures with a load-sharing classification score of 6 and 7 may be stabilized using fewer screws than traditional methods in some patients and allow polytrauma patients to undergo other acute treatment. [Orthopedics. 2018; 41(6):e802-e806.].