Comparison of Surgical Outcomes Between Short-Segment Open and Percutaneous Pedicle Screw Fixation Techniques for Thoracolumbar Fractures

Abstract

BACKGROUND This study aimed to compare the surgical outcomes between open pedicle screw fixation (OPSF) and percutaneous pedicle screw fixation (PPSF) for the treatment of thoracolumbar fractures, which has received scant research attention to date. MATERIAL AND METHODS Eight-four patients with acute and subacute thoracolumbar fractures who were treated with SSPSF from January 2013 to June 2014 at the Changzhou Hospital of Traditional Chinese Medicine (Changzhou, China) were retrospectively reviewed. The patients were divided into 4 groups: the OPSF with 4 basic screws (OPSF-4) group, the OPSF with 4 basic and 2 additional screws (OPSF-6) group, the PPSF with 4 basic screws (PPSF-4) group, and the PPSF with 4 basic and 2 additional screws (PPSF-6) group. The intraoperative, immediate postoperative, and over 1-year follow-up outcomes were evaluated and compared among these groups. RESULTS Blood loss in the PPSF-4 group and the PPSF-6 group was significantly less than in the OPSF-4 group and the OPSF-6 group (P<0.05). The OPSF-6 group exhibited significantly higher immediate postoperative correction percentage of anterior column height of fractured vertebra than the other 3 groups (P<0.05), and higher correction of sagittal regional Cobb angle and kyphotic angle of injured vertebra than in the PPSF-4 and -6 groups (P<0.05). In addition, there was no significant difference in the correction loss of percentage of anterior column height, and loss of sagittal Cobb angle and kyphotic angle of fractured vertebrae at final follow-up among the 4 groups (P>0.05). CONCLUSIONS OPSF with 6 screws had an advantage in the correction of injured vertebral height and kyphosis, and PPSF reduced the intraoperative blood loss of patients.

Figure 1A–F

Lateral X-ray radiographs of vertebral fractures of representative patients from OPSF-4, -6, PPSF-6, and -6 screw groups before, immediately after, and 12 months after the surgery. (A–C) Lateral view radiographs of a 47-year-old male patient with Denis type IB vertebral fracture (at L1) in the OPSF-4 group before (A), immediately after (B), and 12 months after the surgery (C). (D–F) Lateral view radiographs of a 57-year-old female patient with type IIB vertebral fracture (at L2) in the OPSF-6 group before (D), immediately after (E), and 12 months after the surgery (F).

Figure 1G–L

Lateral X-ray radiographs of vertebral fractures of representative patients from OPSF-4, -6, PPSF-6, and -6 screw groups before, immediately after, and 12 months after the surgery. (G–I) Lateral view radiographs of a 45-year-old male patient with type IB vertebral fracture (at L2) in thePPSF-4 group before (G), immediately after (H), and 12 months after the surgery (I). (J–L) Lateral view radiographs of a 51-year-old female patient with type IIB vertebral fracture (at L2) in the PPSF-6 group before (J), immediately after (K), and 12 months after the surgery (L).