DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20210628

Analysis of outcome of percutaneous versus open pedicle screw fixation in the treatment of thoraco-lumbar spine fractures: a prospective comparative study

Raj Kumar, Bhaskar Sarkar, Syed Ifthekar, Samarth Mittal, Pankaj Kandwal, Quamar Azam

Abstract


Background: Aim of the study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation in the treatment of traumatic thoracolumbar burst fractures with spinal injury.

Methods: A prospective comparative study including thirty patients with thoracolumbar burst fracture were equally divided into an open pedicle screw fixation (OPSF) group and a percutaneous pedicle screw fixation (PPSF) group. Demographic characteristics, clinical and radiological outcomes, and adverse events were assessed and compared between the 2 groups.

Results: Demographic and clinical features including age, gender, fracture level, mechanism of injury and neurological status in both groups were not significantly different (all p>0.05). The PPSF group exhibits significantly lower operative time, intraoperative blood loss, and hospital stay compared with the OPSF group (all p<0.05). There was no significant difference in the sagittal Cobb′s angle (CA), fracture vertebral body angle (VBA), anterior vertebral body height (AVBH) on pre-operative, immediate post-operative and final follow up between the two surgical techniques (all p>0.05). Visual analogue scale (VAS) remarkably decreased in both groups after surgery but difference was not statically significant (p=0.808). Common postoperative complications in both groups were superficial infections, pressure ulcer and urinary tract infection (UTI) worsening. Hardware failure was seen only in one case of PPSF group.

Conclusions: Patients with thoracolumbar burst fractures can be effectively managed with PPSF/OPSF. There were no significant differences in radiological and clinical outcomes and post-op complications between 2 groups but blood loss, operative time and hospitalization stay were less in percutaneous group, which may represent a potential benefit.

 


Keywords


Thoraco-lumbar burst fracture, OPSF, PPSF, Prospective comparative study

Full Text:

PDF

References


Samelson EJ, Hannan MT, Zhang Y, Genant HK, Felson DT, Kiel DP. Incidence and risk factors for vertebral fracture in women and men: 25-year follow-up results from the population-based Framingham study. J Bone Miner Res 2006;21:1207-14.

Leucht P, Fischer K, Muhr G, Mueller EJ. Epidemiology of traumatic spine fractures. Injury 2009;40:166-72.

Patil RP, Joshi V, Pamecha C, Kumar P, Bisnoi UP, Singh O. Comparative Study Between Short Segment Open Versus Percutaneous Pedicle Screw Fixation with Indirect Decompression in Management of Acute Burst Fracture of Thoracolumbar and Lumbar Spine with Minimal Neurological Deficit in Adults. J Spine. 2016;5:339.

Tian F, Tu LY, Gu WF, Zhang EF, Wang ZB, Chu G, et al. Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures. A systematic review and meta-analysis. Medicine. 2018;97:1-12.

Ajay MB, Vijayakumar AV. Comparative study between conventional open spine pedicle screw fixation surgery and minimally invasive percutaneous pedicle screw fixation in the management of thoracolumbar spine fracture in adult. Int J Ortho Sci. 2016;2:154-9.

Wang MY. Percutaneous thoracolumbar pedicle screw fixation: is it time to revisit spinal fracture treatment? World Neurosurg. 2010;74:570-1.

Fennell VS, Palejwala S, Skoch J, Stidd DA, Baaj AA. Freehand thoracic pedicle screw technique using a uniform entry point and sagittal trajectory for all levels: preliminary clinical experience. J Neurosurg Spine. 2014;21:778-84.

Alvine GF, Swain JM, Asher MA, Burton DC. Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis: case series and literature review. J Spinal Disord Tech. 2004;17:251-64.

Kim DY, Lee SH, Chung SK, Lee HY. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine. 2005;30:123-9.

Rampersaud YR, Annand N, Dekutoski MB. Use of minimally invasive surgical techniques in the management of thoracolumbar trauma: current concepts. Spine 2006;31:S96-102.

Smith JS, Ogden AT, Fessler RG. Minimally invasive posterior thoracic fusion. Neurosurg Focus. 2008;25:E9.

Youkilis AS, Quint DJ, McGillicuddy JE, Papadopoulos SM. Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery. 2001;48:771-8.

Lee JY, Vaccaro AR, Lim MR, Öner FC, Hulbert RJ, Hedlund R et al. Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. J Orthop Sci. 2005;10:671-5.

Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C et al. AOSpine thoracolumbar spine injury classification system. Fracture description, neurological status, and key modifiers. Spine. 2013;38:2028-37.

Roberts TT, Leonard GR, Cepela DJ. Classifications in Brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res. 2017;475:1499-1504.

Heary RF, Kumar S. Decision-making in burst fractures of the thoracolumbar and lumbar spine. Indian J Orthop. 2007;41:268-76.

Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures. Spine J. 2014;14:145-64.

Cimatti M, Forcato S, Polli F, Miscusi M, Frati A, Raco A. Pure percutaneous pedicle screw fixation without arthrodesis of 32 thoraco-lumbar fractures: clinical and radiological outcome with 36-month follow-up. Eur Spine J. 2013;22:925-32.

Wang B, Fan Y, Dong J, Wang H, Wang F, Liu Z et al. A retrospective study comparing percutaneous and open pedicle screw fixation for thoracolumbar fractures with spinal injuries. Medicine (Baltimore) 2017;96:e8104.

Phan K, Rao PJ, Mobbs RJ. Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg. 2015;135:85-92.

Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Radiological study on disc degeneration of thoracolumbar burst fractures treated by percutaneous pedicle screw fixation. Eur Spine J. 2013;22:489-94.

Fan Y, Zhang J, He X, Hang Y, Wu Q, Hao D. A Comparison of the Mini-Open Wiltse Approach with Pedicle Screw Fixation and the Percutaneous Pedicle Screw Fixation for Neurologically Intact Thoracolumbar Fractures. Med Sci Monit. 2017;23:5515-21.

Li K, Li Z, Ren X, Xu H, Zhang W, Luo D et al. Effect of the percutaneous pedicle screw fixation at the fractured vertebra on the treatment of thoracolumbar fractures. Int Orthop. 2016;40:1103-10.