Short-segment percutaneous fusion versus open posterior fusion with screw in the fractured vertebra for thoracolumbar junction burst vertebral fracture treatment

Abstract

Objectives: The treatment options for thoracolumbar junction burst fractures remain a topic of controversy. Short-segment percutaneous fixation (SSPF) and short-segment open fixation including the fractured level (SSOFIFL) are both viable procedures for managing these fractures. At present, there is a lack of evidence in the literature demonstrating the absolute superiority of one treatment over the other. This study aimed to compare these two surgical strategies with a focus on radiological and clinical outcomes.

Materials and methods: This retrospective case-control multicenter analysis involved patients with A3 and A4 vertebral fractures at the thoracolumbar junction (T11-L2) who underwent surgical treatment with either SSPF or SSOFIFL in the participating centers. Clinical outcomes were measured using the Oswestry Disability Index and visual analogue scale (VAS) both pre- and postoperatively. Radiological outcomes included kyphotic deformity (KD), anterior vertebral body height (AVBH), segmental kyphosis, and sagittal alignment parameters.

Results: A total of 156 patients were enrolled in the study, with 81 patients in Group A (SSPF) and 75 patients in Group B (SSOFIFL). Group B demonstrated better correction of KD (Group B: 3.4 ± 2.7° vs. Group A: 8.3 ± 3.2°, P = 0.003), AVBH, and sagittal alignment. A minor loss of correction was observed in Group B with respect to Group A (0.9 ± 1.7° vs 4.3° ± 2.1°, P = 0.043). Blood losses were lower in Group A (78 ± 15 min vs. 118 ± 23 min, P = 0.021) as well as during surgery (121.3 ± 34 mL vs. 210.2 ± 52 mL, P = 0.031), but the post-operative hemoglobin levels were comparable between the two groups.

Conclusion: SSOFIFL appears to show a major amount of KD correction and prevent loss of correction. This technique should be the preferred choice whenever possible. However, SSPF can be considered a valid alternative for damage control in polytrauma patients and fractures with low KD.

Keywords: Minimally invasive systems; Percutaneous pedicle screws; Short-segment fixation; Spinal surgery; Thoracolumbar burst fractures.

Figure 1:

Simplification of radiographic parameters measured. AVBH: Anterior vertebral body height, SK: Segmental kyphosis, SI: Sagittal index, SNC: Sagittal normal contour. KD: Kyphotic deformity

Figure 2:

An exemplary case of a male 59-year-old patient belonging to Group A: (a) Sagittal view of thoracolumbar spine computer tomography scan with L1 A3 fracture. (b) Pre-operative lateral view spinal X-ray and an angular Kyphosis of 16°, SI = 16. (c) Post-operative lateral view spine X-ray images showing 7° kyphotic deformity improvement. KD: Kyphotic deformity, AVBH: Anterior vertebral body height.

Figure 3:

An exemplary case of a male 57-year-old patient belonging to Group B: (a) Sagittal view of thoracolumbar spine computer tomography scan with L2 A4 fracture. (b) Pre-operative lateral view spinal X-ray and an angular kyphosis of 14°, SI = 22. (c) Post-operative lateral view spine X-ray images showing 13° kyphotic deformity improvement. KD: Kyphotic deformity, AVBH: Anterior vertebral body height