Clinical efficacy of decompression under full-endoscope and percutaneous pedicle screw fixation in the treatment of single-level thoracolumbar burst fracture

English Keywords:Thoracolumbar burst fracture  Full-endoscope  Spinal canal decompression  Percutaneous pedicle screw fixation

English Abstract:

  【Abstract】 Objectives: To explore the safety and early effectiveness of decompression under full-endoscope and percutaneous pedicle screw fixation in the treatment of single-level thoracolumbar burst fractures. Methods: The clinical data of 9 patients with single-segment thoracolumbar burst fracture treated with spinal canal decompression under full-endoscope and percutaneous pedicle screw fixation from April 2021 to June 2022 in our hospital were analyzed retrospectively, including 7 males and 2 females. The age ranged from 23 to 61(39.3±9.1) years old. According to AO classification, there were 6 cases of type A, 2 cases of type B and 1 case of type C. Fracture segments were T12 in 2 cases, L1 in 3 cases, L2 in 3 cases, and L3 in 1 case. According to the classification of American Spinal Injury Association(ASIA) grading, there were 2 cases of type C, 2 cases of type D, and 5 cases of type E. The decompression and percutaneous pedicle screw fixation were operated through the same incision in the injured vertebrae for screw placing. The operation-related indexes and complications were recorded. The patients′ low back pain was evaluated by visual analogue scale(VAS) score before operation, on 3rd day after operation and at the last follow-up. The sagittal Cobb angle, height ratio of vertebral anterior edge, and the rate of spinal canal occupation were measured on spinal X-ray and CT images, and the recovery of neurological function was evaluated at the last follow-up. Results: All 9 patients successfully completed the operation, and the operative time was 105-145min(112.4±21.2min), bleeding volume was 50-110mL(83.9±19.6mL), and hospitalization time was 7-13d(9.1±1.3d). No serious complications such as wound infection, cerebrospinal fluid leakage, aggravated nerve injury occurred. The follow-up time was 6-13months(8.4±3.9 months), all the fractures healed successfully, and the healing time was 3-6 months(4.7±1.6 months). The VAS score of low back pain on the 3rd day after operation and at final follow-up significantly improved compared with that before operation(P<0.05), and it was also significantly improved at the last follow-up compared with that on the 3rd day after operation(P<0.05). The Cobb angle, anterior height ratio of injured vertebrae, and invasion rate of spinal canal were significantly improved compared with those before operation(P<0.05), respectively, but there was no statistical difference between the last follow-up and postoperative 3d(P>0.05). One patient recovered from grade C to grade D of ASIA classification, while another three patients with neurological injury recovered completely. Conclusions: Decompression under full-endoscope and percutaneous pedicle screw fixation through the same incision in the injured vertebrae for screw placement in the treatment of single-level thoracolumbar burst fractures can obtain effective nerve root and spinal canal decompression, with good correction and small operative trauma, which is a safe and effective option.