Comparison of Intraoperative Blood Loss between Percutaneous Pedicle Screw Fixation with Minimally Invasive Decompressive Laminectomy and Open Screw Fixation with Decompressive Laminectomy, in Traumatic Spine Fracture with Spinal Cord Injury
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Abstract
BACKGROUND: Traumatic thoracolumbar fractures are common spinal injuries, often occurring in the T10–L2 transition zone. When neurological deficits are present, surgical decompression and stabilization are required. Traditional open screw fixation with decompressive laminectomy (OS) is effective but causes considerable paraspinal muscle injury and intraoperative blood loss.
OBJECTIVE: To compare intraoperative blood loss (mL) between percutaneous pedicle screw fixation with minimally invasive decompression (PSMD) and OS in patients aged 18–65 suffering from traumatic thoracolumbar burst fractures and acute neurological deficits.
METHODS: A retrospective cohort study at Phrapokklao Hospital included 36 patients treated between 2022 and 2025, divided into PSMD (n=18) and OS (n=18). The primary outcome was intraoperative blood loss; secondary outcomes were operative time, length of hospital stay, radiological Cobb angle correction, and neurological recovery by motor power score at 12 weeks.
RESULTS: PSMD significantly reduced crude blood loss versus OS (350.0 mL [IQR 200.0–600.0] vs. 650.0 mL [500.0–1,000.0], p=0.003), a benefit that persisted after multivariable adjustment (adjusted mean difference −428.67 mL, 95% CI −682.40 to −174.93 mL, p=0.002). Operative time was shorter with PSMD (127.5 min [120.0–150.0] vs. 180.0 min [165.0–200.0], p<0.001). Crude length of stay favored PSMD (11.5 days [10.0–18.0] vs. 17.0 [15.0–19.0], p=0.029), attenuating to a trend after adjustment (−6.94 days, p=0.08). No significant differences were found in adjusted Cobb angle correction (−0.45°, p=0.99) or 3-month lower-extremity motor improvement (−2.53, p=0.22).
CONCLUSIONS: PSMD is an effective, less invasive alternative to open surgery for traumatic thoracolumbar fractures with neurological injury, providing equivalent radiological and neurological outcomes while significantly reducing intraoperative blood loss and operative time.
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