Postoperative Outcome of Short Segment Percutaneous Screw Fixation Compare with Long Segment Fixation in Thoracolumbar Fracture
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Published:
Oct 1, 2019
Keywords:
Thoracolumbar spine Spinal fractures Minimal invasive surgery Pedicle screws Fracture reduction
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Abstract
Objectives: To evaluate the postoperative outcome of percutaneous pedicle screw fixation (PPSF) using the proposed technique in the treatment of thoracolumbar spine fracture compared to an open long segment pedicle screw fixation technique (OPSF).
Materials and Methods: A retrospective review of 49 cases of unstable thoracolumbar spine fracture patients (Burst fracture 44 cases and flexion-distraction 5 cases) without neuro deficit that treated at Maharat Nakhon Ratchasima hospital from January 2015 - December 2017. Demographics data, postoperative visual analog scale, intraoperative blood loss and length of stay were collected from medical records. Postoperative radiographic parameters were collected from the CT scan.
Results: The mean kyphosis reduction was 11.2±4.6 degrees in the PPSF group and 11.5±4.8 degrees in the OPSF group. Mean canal diameter increase was 17.81±16.46 and 18.83±15.36 mm2 respectively. Mean VAS reduction was 4.55±1.87 and 4.63±2.16 respectively. There was no significant difference between the two groups in these three parameters (all P-values > .05). There was a statistically significant difference in intraoperative blood loss which was 56.36±36.64 ml in PPSF and 124.38±59.89 ml in OPSF (P < .05). Postoperative length of stay was no significantly difference between the both groups (PPSF 5.7±2.2 and OPSF5.8±2.1 respectively, P = .86).
Conclusions: In terms of postoperative outcome, there were lack of evidence to detect the difference between PPSF and OPSF in postoperative radiologic outcomes, VAS reduction, postoperative length of stay and complications, but PPSF could reduce intraoperative blood loss.
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References
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23. Loibl M, Korsun M, Reiss J, Gueorguiev B, Nerlich M, Neumann C, et al. Spinal fracture reduction with a minimal-invasive transpedicular Schanz Screw system: clinical and radiological one-year follow-up. Injury. 2015; 46 Suppl 4: S75-82.
24. Chou D, Wang VY, Storm PB. Pedicle subtraction osteotomies for the correction of post-traumatic thoracolumbar kyphosis. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2010; 17(1): 113-7.
25. Grossbach AJ, Dahdaleh NS, Abel TJ, Woods GD, Dlouhy BJ, Hitchon PW. Flexion-distraction injuries of the thoracolumbar spine: open fusion versus percutaneous pedicle screw fixation. Neurosurgical focus. 2013; 35(2): E2.
26. Rahul PP, 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. Journal of Spine. 2016; 05(2165-7939): 1-5.
27. Korovessis P, Mpountogianni E, Syrimpeis V. Percutaneous pedicle screw fixation plus kyphoplasty for thoracolumbar fractures A2, A3 and B2. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2017; 26(5): 1492-8.
28. Li C, Pan J, Gu Y, Dong J. Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty for the treatment of thoracolumbar burst fracture. International journal of surgery (London, England). 2016; 36(Pt A): 255-60.
29. Ni WF, Huang YX, Chi YL, Xu HZ, Lin Y, Wang XY, et al. Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. Journal of spinal disorders & techniques. 2010; 23(8): 530-7.
30. Wang HW, Li CQ, Zhou Y, Zhang ZF, Wang J, Chu TW. Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases. Chinese journal of traumatology = Zhonghua chuang shang za zhi. 2010; 13(3): 137-45.
2. Hasler RM, Exadaktylos AK, Bouamra O, Benneker LM, Clancy M, Sieber R, et al. Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011; 20(12): 2174-80.
3. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983; 8(8): 817-31.
4. Vaccaro AR, Lehman RA, Jr., Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine. 2005; 30(20): 2325-33.
5. Vaccaro AR, Zeiller SC, Hulbert RJ, Anderson PA, Harris M, Hedlund R, et al. The thoracolumbar injury severity score: a proposed treatment algorithm. Journal of spinal disorders & techniques. 2005;18(3):209-15.
6. Lenarz CJ, Place HM. Evaluation of a new spine classification system, does it accurately predict treatment? Journal of spinal disorders & techniques. 2010; 23(3): 192-6.
7. 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. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2013; 22 Suppl 6: S925-32.
8. 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(1): 123-9.
9. McAnany SJ, Overley SC, Kim JS, Baird EO, Qureshi SA, Anderson PA. Open Versus Minimally Invasive Fixation Techniques for Thoracolumbar Trauma: A Meta-Analysis. Global spine journal. 2016; 6(2): 186-94.
10. 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. Clinical neurology and neurosurgery. 2015; 135: 85-92.
11. Vanek P, Bradac O, Konopkova R, de Lacy P, Lacman J, Benes V. Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up. Journal of neurosurgery Spine. 2014; 20(2): 150-6.
12. Wang H, Zhou Y, Li C, Liu J, Xiang L. Comparison of Open Versus Percutaneous Pedicle Screw Fixation Using the Sextant System in the Treatment of Traumatic Thoracolumbar Fractures. Clinical spine surgery. 2017; 30(3): E239-e46.
13. Wild MH, Glees M, Plieschnegger C, Wenda K. Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures: a comparison of minimally invasive percutaneously and conventionally open treated patients. Archives of orthopaedic and trauma surgery. 2007; 127(5) : 335-43.
14. Wiltse LL, Bateman JG, Hutchinson RH, Nelson WE. The paraspinal sacrospinalis-splitting approach to the lumbar spine. The Journal of bone and joint surgery American volume. 1968; 50(5): 919-26.
15. Liu Z, Li Z, Xing D, Gao H, Peng C, Gong M. Two different surgery approaches for treatment of thoracolumbar fracture. International journal of clinical and experimental medicine. 2015; 8(12): 22425-9.
16. Li H, Yang L, Xie H, Yu L, Wei H, Cao X. Surgical outcomes of mini-open Wiltse approach and conventional open approach in patients with single-segment thoracolumbar fractures without neurologic injury. Journal of biomedical research. 2015; 29(1): 76-82.
17. Knop C, Bastian L, Lange U, Oeser M, Zdichavsky M, Blauth M. Complications in surgical treatment of thoracolumbar injuries. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2002; 11(3): 214-26.
18. Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clinical orthopaedics and related research. 1984(189): 125-41.
19. Lee JK, Jang JW, Kim TW, Kim TS, Kim SH, Moon SJ. Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures: is it effective?: comparative study with open short-segment pedicle screw fixation with posterolateral fusion. Acta neurochirurgica. 2013; 155(12): 2305-12.
20. Fitschen-Oestern S, Scheuerlein F, Weuster M, Klueter T, Menzdorf L, Varoga D, et al. Reduction and retention of thoracolumbar fractures by minimally invasive stabilisation versus open posterior instrumentation. Injury. 2015; 46 Suppl 4: S63-70.
21. Dong SH, Chen HN, Tian JW, Xia T, Wang L, Zhao QH, et al. Effects of minimally invasive percutaneous and trans-spatium intermuscular short-segment pedicle instrumentation on thoracolumbar mono-segmental vertebral fractures without neurological compromise. Orthopaedics & traumatology, surgery & research : OTSR. 2013; 99(4): 405-11.
22. 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. International orthopaedics. 2016; 40(6): 1103-10.
23. Loibl M, Korsun M, Reiss J, Gueorguiev B, Nerlich M, Neumann C, et al. Spinal fracture reduction with a minimal-invasive transpedicular Schanz Screw system: clinical and radiological one-year follow-up. Injury. 2015; 46 Suppl 4: S75-82.
24. Chou D, Wang VY, Storm PB. Pedicle subtraction osteotomies for the correction of post-traumatic thoracolumbar kyphosis. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2010; 17(1): 113-7.
25. Grossbach AJ, Dahdaleh NS, Abel TJ, Woods GD, Dlouhy BJ, Hitchon PW. Flexion-distraction injuries of the thoracolumbar spine: open fusion versus percutaneous pedicle screw fixation. Neurosurgical focus. 2013; 35(2): E2.
26. Rahul PP, 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. Journal of Spine. 2016; 05(2165-7939): 1-5.
27. Korovessis P, Mpountogianni E, Syrimpeis V. Percutaneous pedicle screw fixation plus kyphoplasty for thoracolumbar fractures A2, A3 and B2. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2017; 26(5): 1492-8.
28. Li C, Pan J, Gu Y, Dong J. Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty for the treatment of thoracolumbar burst fracture. International journal of surgery (London, England). 2016; 36(Pt A): 255-60.
29. Ni WF, Huang YX, Chi YL, Xu HZ, Lin Y, Wang XY, et al. Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. Journal of spinal disorders & techniques. 2010; 23(8): 530-7.
30. Wang HW, Li CQ, Zhou Y, Zhang ZF, Wang J, Chu TW. Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases. Chinese journal of traumatology = Zhonghua chuang shang za zhi. 2010; 13(3): 137-45.