Comparison of clinical results between percutaneous and traditional open pedicle screw fixation for thoracolumbar fractures without neurological deficit

English Keywords:Thoracolumbar fractures  Minimally invasive surgery  Percutaneous pedicle screw fixation  Pedicle screws

English Abstract:

  【Abstract】 Objectives: To compare the efficacy and safety of percutaneous pedicle screw fixation and traditional open surgery for thoracolumbar fractures without neurological deficit. Methods: Seventy adult patients with single thoracolumbar fracture between April 2009 and April 2012 were recruited in this study. Those patients aged from 18 to 60 years old and were injured within two weeks. All patients had single level thoracolumbar spine fracture, with pedicles and facet joints intact and vertebral body compression less than 50%. All cases were divided as percutaneous pedicle screw fixation group(group A) and traditional open surgery group(group B). Group A was undergoing percutaneous pedicle screw fixation including 32 patients (23 males, 9 females, average age of 42.24y). Group B was undergoing traditional open surgery including 38 patients(28 males, 10 females, average age of 41.23y). Functional outcomes of preoperation and final follow-up were evaluated by visual analog scale(VAS) and Oswestry disability index(ODI). Clinical and surgical evaluation including surgery time, blood loses, hospital stay and complication were performed. Cobb angle and front height loss of fracture vertebral before surgery, Cobb angle restoration and fracture vertebral body front height restoration rate after surgery, Cobb angle loss and fracture vertebral body front height loss rate were assessed from lateral lumbar X-ray for radiological evaluation. Results: There were no statistical differences between two groups in age, gender, injury site, Cobb angle, anterior height of fracture vertebral body, VAS and ODI(P＞0.05). The average operation time of group A was 48.38±2.24mins, blood loss was 55.00±21.24ml, hospital stay was 5.03±0.78d, the period of return to daily life after surgery was 14.64±6.32d, hospitalization expense was 5.21±0.78 ten thousand yuan. The average operation time of group B was 88.43±5.28min, blood loss was 153.00±33.24ml, hospital stay was 7.02±1.23d, the period of return to daily life after surgery was 30.25±6.14d, hospitalization expense was 3.33±1.23 ten thousand yuan. There were significantly statistical differences between two groups in operation time, blood loss, hospital stay, period of return to daily life after surgery, hospitalization expenses(P＜0.001). No complication in group A and 1 case of superficial skin incision infection was noted in group B. There were no statistical differences in terms of complication and Cobb angle restoration and fracture height restoration rate after surgery, Cobb angle loss and fracture vertebral body front height loss rate at final follow up between two approaches(P＞0.05). Conclusions: Both percutaneous and traditional open pedicle screw fixation have good clinical results for thoracolumbar fractures without neurological deficit. But percutaneous pedicle screw fixation group has shorter operation time, less blood loses, shorter hospital stay and recovery period but more hospital costs. This procedure is safe and minimally invasive under strict surgical indications.