Percutaneous short-segment pedicle screw fixation using pedicle fixation at fractured level without fusion in the treatment of type A3 or A4 thoracolumbar fractures

English Keywords:Thoracolumbar fracture  Pedicle screw  Minimally invasive  Percutaneous  Internal fixation

English Abstract:

  【Abstract】 Objectives: To explore the clinical result of percutaneous short-segment pedicle screw fixation using pedicle fixation at fractured level without fusion for type A3 or A4 thoracolumbar fractures. Methods: Between September 2013 and February 2014, 60 patients suffering from thoracolumbar single-level vertebral fractures(type A3 or type A4, load sharing ≤ 6, without neurological deficit) were reviewed retrospectively. All cases were divided into two groups: percutaneous group (percutaneous short-segment pedicle screw fixation at fractured level without fusion) and trans-spatium intermuscular group (trans-spatium intermuscular short-segment pedicle screw fixation using pedicle fixation at fractured level without fusion). There were no significant differences in gender, age, type of fracture and level of fracture between the two groups. The perioperative parameters (including the length of incision, the operation time, the intraoperative blood loss and the VAS after operation) and radiographic parameters(including the anterior vertebral body height and the Cobb angle) were compared. Results: In percutaneous group, the length of incision was 9.55±1.76cm, the time of operation was 120.7±24.5min, the intraoperative blood loss was 50.6±13.7ml and the VAS after operation was 3.5±1.0 points; while in trans-spatium intermuscular group, the data were 10.80±1.52cm, 90.3±15.6min, 152.0±25.8 and 5.1±1.7 points respectively, which showed significant differences between the two groups(P＜0.05) except for the length of incision. In percutaneous group, the anterior vertebral body height and Cobb angle after operation, at the time of fixation removal and at final follow-up were 86.5±7.9% and 3.7±4.5°, 84.5±8.1% and 3.9±5.0°, 83.9±5.7% and 3.6±4.5° respectively. While in trans-spatium intermuscular group, the data were 88.1±8.6% and 3.2±5.1°, 86.3±8.3% and 3.8±5.4°, 85.6±7.1% and 3.7±4.8° respectively. Compared with preoperation, the anterior vertebral body height and Cobb angle after operation improved significantly in both groups(P＜0.05). Compared with the postoperation, there was no significant difference with regard to the recovery outcome between the time for fixation removal and the final follow-up in both groups(P＞0.05). There were no significant differences in radiographic parameters between the two groups. Conclusions: Percutaneous short-segment pedicle screw fixation using pedicle fixation at the level of fracture without fusion is a reliable surgical method for the treatment of type A3 and type A4 thoracolumbar fractures with the advantages of less intraoperative blood loss and less VAS after operation.