Comparative study of posterior mini-open decompression combined with percutaneous pedicle screw fixation vs traditional open reduction and internal fixation for thoracolumbar fracture complicated with neurological deficits

English Keywords:Thoracolumbar fracture  Mini-open decompression  Percutaneous pedicle screw fixation  Neurological deficits

English Abstract:

  【Abstract】 Objectives: To compare the outcome of posterior mini-open decompression combined with percutaneous pedicle screw fixation with that of traditional open reduction and internal fixation for thoracolumbar fracture complicated with neurological deficits. Methods: 56 cases with neurological deficits of thoracolumbar fracture in our hospital from December 2011 to June 2014 were undertaken, 26 cases underwent posterior mini-open decompression combined with percutaneous pedicle screw fixation(MISS group), while 30 cases underwent traditional open posterior decompression and pedicle screw fixation(Open group), perioperative indexs, the imaging indexes, the neurological function recovery and complication incidence in two groups were compared. Results: The skin incision length, blood loss, postoperative drainage volume, transfusion proportion, postoperative hospital stay, visual analogue score(VAS score) and postoperative analgesics usage in MISS group was 7.46±2.67cm, 271.54±125.53ml, 74.50±73.58ml, 9/17, 19.19±10.66d, 2.54±0.65 and 11/15, respectively, while 12.17±4.38cm, 536.67±453.52ml, 310.97±209.65ml, 19/11, 31.17±26.92d, 3.60±0.77 and 21/9, respectively in the Open group, which showed significant differences(P＜0.05) between 2 groups, but the operation time between two groups(222.88±64.41 and 190.83±83.19min) showed no difference(P>0.05). In MISS group, preoperative and postoperative sagittal Cobb angle, vertebral height percentage, sagittal index and vertebral wedging angle was (10.51±16.12°, 0.70±12.97°), (52.27±8.34%, 86.64±12.80), (14.63±10.29°, 7.43±6.79°) and (13.45±7.40°, 4.07±4.81°) respectively, while (15.04±9.84, 2.96±9.84), (48.58±11.48, 86.63±9.76), (20.67±17.58, 7.38±5.63) and (14.16±6.77, 4.26±4.39) respectively for Open group. In both group, the postoperative imaging indexes significantly improved compared with the preoperative ones(P＜0.05), but the improved rate(postoperative - preoperative) showed no statistical difference(P>0.05). At later follow-up, nerve function recovery, as well as complication rates showed no statistical significance between 2 groups(P>0.05). Conclusions: Posterior mini-open decompression combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar fracture with neurological deficits has the same effects as traditional open surgery, and has a small incision, less blood loss, shorter hospital stay, less wound pain and other advantages.