Comparison of Percutaneous versus Open Pedicle Screw Fixation for Treating Unstable Thoracolumbar Fractures

Jin Young Han; Ki Youn Kwon

doi:10.12671/jkfs.2020.33.1.1

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Original Article Comparison of Percutaneous versus Open Pedicle Screw Fixation for Treating Unstable Thoracolumbar Fractures: Jin Young Han, Ki Youn Kwon; Journal of Musculoskeletal Trauma 2020;33(1):1-8.
DOI: https://doi.org/10.12671/jkfs.2020.33.1.1
Published online: January 31, 2020

Department of Orthopedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea. 1stspinekky@yonsei.ac.kr

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Abstract

PURPOSE
This study compared the clinical and radiological results between two groups of patients with percutaneous fixation or conventional fixation after hardware removal.
MATERIALS AND METHODS
The study analyzed 68 patients (43 open fixation and 43 percutaneous screw fixation [PSF] 25) who had undergone fixation for unstable thoracolumbar fractures. The radiologic results were obtained using the lateral radiographs taken before and after the fixation and at the time of hardware removal. The clinical results included the time of operation, blood loss, time to ambulation, duration of the hospital stay and the visual analogue scale.
RESULTS
The percutaneous pedicle screw fixation (PPSF) group showed better results than did the conventional posterior fixation (CPF) group (p<0.05) in regard to the perioperative data such as operation time, blood loss, and duration of the hospital stay. There were no significant differences in wedge angle, local kyphotic angle, and the Î”Kyphotic angle on the postoperative plane radiographs between the two groups (p>0.05). There were no significant differences in the wedge angle and local kyphotic angle after implant removal (p>0.05) between the two groups as well. However, there were significant differences in the segmental montion angle (p<0.001), and the PPSF group showed a larger segmental motion angle than did the CPF group (CPF 1.7Â°Â±1.2Â° vs PPSF 5.9Â°Â±3.2Â°, respectively).
CONCLUSION
For the treatment of unstable thoracolumbar fractures, the PPSF technique could achieve better clinical results and an improved segmental motion angle after implant removal within a year than that of the conventional fixation method.

Keywords: Unstable thoracolumbar vertebral fracture, Conventional posterior fixation, Percutaneous pedicle screw fixation, Implant removal, Segmental motion angle

J Korean Fract Soc. 2020 Jan;33(1):1-8. Korean.
Published online Jan 23, 2020.
https://doi.org/10.12671/jkfs.2020.33.1.1

Original Article

Comparison of Percutaneous versus Open Pedicle Screw Fixation for Treating Unstable Thoracolumbar Fractures

Jin Young Han

, M.D. and Ki Youn Kwon

, M.D.

Author information

Author notes

- Department of Orthopedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
Correspondence to: Ki Youn Kwon, M.D. Department of Orthopedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea. Tel: +82-33-741-1356, Fax: +82-33-741-1365, Email: 1stspinekky@yonsei.ac.kr

Received December 10, 2019; Revised December 19, 2019; Accepted December 19, 2019.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study compared the clinical and radiological results between two groups of patients with percutaneous fixation or conventional fixation after hardware removal.

Materials and Methods

The study analyzed 68 patients (43 open fixation and 43 percutaneous screw fixation [PSF] 25) who had undergone fixation for unstable thoracolumbar fractures. The radiologic results were obtained using the lateral radiographs taken before and after the fixation and at the time of hardware removal. The clinical results included the time of operation, blood loss, time to ambulation, duration of the hospital stay and the visual analogue scale.

Results

The percutaneous pedicle screw fixation (PPSF) group showed better results than did the conventional posterior fixation (CPF) group (p<0.05) in regard to the perioperative data such as operation time, blood loss, and duration of the hospital stay. There were no significant differences in wedge angle, local kyphotic angle, and the ΔKyphotic angle on the postoperative plane radiographs between the two groups (p>0.05). There were no significant differences in the wedge angle and local kyphotic angle after implant removal (p>0.05) between the two groups as well. However, there were significant differences in the segmental montion angle (p<0.001), and the PPSF group showed a larger segmental motion angle than did the CPF group (CPF 1.7°±1.2° vs PPSF 5.9°±3.2°, respectively).

Conclusion

For the treatment of unstable thoracolumbar fractures, the PPSF technique could achieve better clinical results and an improved segmental motion angle after implant removal within a year than that of the conventional fixation method.

Keywords

Unstable thoracolumbar vertebral fracture, Conventional posterior fixation, Percutaneous pedicle screw fixation, Implant removal, Segmental motion angle

Figures

Fig. 1
Radiography showing linear and angular measurement. Wedge angle (∠AB°), local kyphotic angle (∠CD°), anterior body height (200×b/(a+c) %), posterior body height (200×e/(d+f) %).

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Fig. 2
The segmental motion angle (SMA) was calculated as the difference between the local kyphotic angle on the flexion (FLEX) and extension (EXT) plain radiograph.

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Fig. 3
A 64-year-old male with flexion-distraction injury on T12. (A) The preoperative lateral X-ray shows fracture of the T12 body and spinous process. (B) On the magnetic resonance imaging (T2 weighted fat suppression), there was acute compression fracture with a spinous process fracture. (C) The lateral radiograph, taken immediately after surgery, shows anatomical reduction. (D, E) Lateral X-ray of the flexion (D)/extension (E) views that show the range of motion of no fusion segment.

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Tables

Table 1
Demographic Note

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Table 2
Perioperative Data for Fixation

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Table 3
Radiologic Results after Posterior Fixation

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Table 4
Radiologic Results 3 Months after Implant Removal

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Notes

Financial support:None.

Conflict of interests:None.

References

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Comparison of Percutaneous versus Open Pedicle Screw Fixation for Treating Unstable Thoracolumbar Fractures

J Korean Fract Soc. 2020;33(1):1-8. Published online January 31, 2020

DOI: https://doi.org/10.12671/jkfs.2020.33.1.1