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

Article information

J Musculoskelet Trauma. 2019;33(1):1-8

Publication date (electronic) : 2019 January 10

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

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 E-mail: 1stspinekky@yonsei.ac.kr Financial support: None. Conflict of interests: None.Purpose:

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

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

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) %).

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.

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.

Table 1.

Demographic Note

Table 2.

Perioperative Data for Fixation

Table 3.

Radiologic Results after Posterior Fixation

Table 4.

Radiologic Results 3 Months after Implant Removal

References

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Article information Continued

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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) %).

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.

Fig. 3.

Table 1.

Demographic Note

Variable	CPF (n=43)	PPSF (n=25)	p-value
Age (yr)	51.7±13.1	50.1±13.9	0.661
Sex, male	31 (72.1)	17 (68.0)	0.721
Injured level			0.971
T12	15 (34.9)	8 (32.0)
L1	18 (41.9)	11 (44.0)
L2	10 (23.3)	6 (24.0)
Cause of injury			0.763
MVA	16 (37.2)	8 (32.0)
Fall	24 (55.8)	16 (64.0)
Rolling down	3 (7.0)	1 (4.0)
Fracture type Unstable			0.673
Unstable burst	28 (65.1)	15 (60.0)
Flexion-distraction	15 (34.9)	10 (40.0)

Values are presented as mean±standard deviation or number (%). CPF: conventional posterior fixation, PPSF: percutaneous pedicle screw fixation, MVA: motor vehicle accident.

Table 2.

Perioperative Data for Fixation

Variable	CPF	PPSF	p-value
Operation time (min)	98.3±15.2	64.9±13.1	0.002
Blood loss (ml)	247±32.1	50.4±23.4	0.012
Ambulation time (d)	3.7±1.8	2.4±1.3	0.041
Hospital stay (d)	10.3±4.1	6.5±2.4	0.002
VAS at POD 1	5.7±1.1	4.5±2.4	0.081

Values are presented as mean±standard deviation. CPF: conventional posterior fixation, PPSF: percutaneous pedicle screw fixation, VAS: visual analogue scale, POD: postoperative day.

Table 3.

Radiologic Results after Posterior Fixation

Variable	CPF	PPSF	p-value
Wedge angle (°)
Preoperative	20.1±6.6	16.1±6.3	0.186
Postoperative	11.1±5.1	10.7±5.4	0.547
ΔWedge angle	9.1±5.4	6.2±2.1	0.034
Kyphotic angle (°)
Preoperative	18.5±10.2	14.1±6.1	0.243
Postoperative	9.3±7.9	16.1±4.6	0.146
ΔKyphotic angle	6.2±3.4	8.1±3.4	0.149
Anterior body height(%)
Preoperative	62.0±15.6	69.3±13.4	0.126
Postoperative	91.3±11.6	85.3±9.3	0.089
Correction	28.3±3.9	17.4±4.3	0.012
Posterior body height(%)
Preoperative	92.7±10.7	97.5±10.2	0.235
Correction	96.0±8.7	98.8±8.7	0.611
Correction	3.1±1.3	2.7±1.1	0.916

Values are presented as mean ± standard deviation. Refer to Fig. 1 for the measurement of anteroposterior body height. CPF: conventional posterior fixation, PPSF: percutaneous pedicle screw fixation.

Table 4.

Radiologic Results 3 Months after Implant Removal

Variable	CPF	PPSF	p-value
Wedge angle (°)
Preoperative	11.4±3.6	10.7±4.3	0.589
Postoperative	11.2±3.7	10.5±4.1	0.550
ΔWedge angle	0.2±0.1	0.2±0.1	0.891
Kyphotic angle (°)
Preoperative	10.1±3.1	6.1±4.6	0.003
Postoperative	12.5±2.4	12.8±3.1	0.248
ΔKyphotic angle	2.5±2.3	6.6±2.8	0.022
Segmental motion angle (°)	1.7±1.2	5.9±3.2	<0.001

Values are presented as mean±standard deviation. CPF: conventional posterior fixation, PPSF: percutaneous pedicle screw fixation.