Журнал позвоночника

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

Abstract

Rahul Pramod Patil, Vinay Joshi, Chirayu Pamecha, Pavan Kumar, Uday Pal Bisnoi and Opender Singh

The objective of this prospective randomized study was to compare the immediate and long-term clinico-radiological outcome of short segment open versus percutaneous pedicle screw fixation with indirect decompression achieved via distracting the posterior pedicle screw construct in management of single level acute thoracolumbar and lumbar burst fracture (TLBF) with minimal neurological deficit in adults.

All patients had burst fracture of less than 72 hours and loss of vertebral body height ≥50%, angulation ≥30⁰, kyphotic deformity ≥20⁰, canal compromise ≥40⁰, failure of at least 2 columns, with intact pedicle and minimum neurological deficit [Grades C and D; according to American Spinal Injury Association (ASIA) grading system.

Fractures treated either via short segment open pedicle screw fixation with indirect decompression (OPSFD) or short segment percutaneous pedicle screw fixation with indirect decompression (PPSFD) techniques, were corrected using a titanium monoaxial pedicle screw construct. Post-operatively all patients were advice brace and subjected for regular physiotherapy and followed up to 1 years. Data regarding peri-operative events, clinico-radiological outcome, duration of hospital stay and period taken to return to work was collected and analysed.

Those patients treated with PPSFD techniques demonstrated superior outcomes compared to conventional OPSFD techniques, with significantly reduced operative time and blood loss during surgery, hospital stay, better neurological outcomes and early return to work. However, there was no significant difference in view of radiological improvement between the two surgical techniques.

We would recommend PPSFD techniques as the best way of treating acute single level TLBF with minimum neurological deficit in adults.