Comparison of a Paraspinal Approach with a Percutaneous Approach in the Treatment of Thoracolumbar Burst Fractures with Posterior Ligamentous Complex Injury: A Prospective Randomized Controlled Trial

Jiang, Xiaoxing; Tian, Wei; Liu, Baiwei; Li, Q; Zhang, G L; Hu, Lin; Zy, Li; He, Da

doi:10.1177/147323001204000413

Cited by 78 publications

(78 citation statements)

References 33 publications

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“…After more than 3 years, the authors concluded that the paraspinal approach is able to correct deformity in the case of unsuccessful postural reduction, but there were no significant differences between groups in long-term stability. 6 Radiological data in our study did not deviate from previously published patient series. We found significant correction in all monitored parameters in both groups, and the percutaneous technique was even slightly better compared with the control group in terms of restoration of VBI.…”

Section: Discussionsupporting

confidence: 57%

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

Vaněk

Bradáč

Konopková

et al. 2014

SPI

109

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Object The main aim of this study was to compare clinical and radiological outcomes after stabilization by a percutaneous transpedicular system and stabilization from the standard open approach for thoracolumbar spine injury. Methods Thirty-seven consecutive patients were enrolled in the study over a period of 16 months. Patients were included in the study if they experienced 1 thoracolumbar fracture (A3.1–A3.3, according to the AO/Magerl classification), had an absence of neurological deficits, had no other significant injuries, and were willing to participate. Eighteen patients were treated by short-segment, minimally invasive, percutaneous pedicle screw instrumentation. The control group was composed of 19 patients who were stabilized using a short-segment transpedicular construct, which was performed through a standard midline incision. The pain profile was assessed by a visual analog scale (VAS), and overall satisfaction by a simple 4-stage scale relating to performance of daily activities. Working ability and return to original occupation were also monitored. Radiographic follow-up was defined by the vertebral body index (VBI), vertebral body angle (VBA), and bisegmental Cobb angle. The accuracy of screw placement was examined using CT. Results The mean surgical duration in the percutaneous screw group was 53 ± 10 minutes, compared with 60 ± 9 minutes in the control group (p = 0.032). The percutaneous screw group had a significantly lower perioperative blood loss of 56 ± 17 ml, compared with 331 ± 149 ml in the control group (p < 0.001). Scores on the VAS in patients in the percutaneous screw group during the first 7 postoperative days were significantly lower than those in the control group (p < 0.001). There was no significant difference between groups in VBI, VBA, and Cobb angle values during follow-up. There was no significant difference in screw placement accuracy between the groups and no patients required surgical revision. There was no significant difference between groups in overall satisfaction at the 2-year follow-up (p = 0.402). Working ability was insignificantly better in the percutaneous screw group; previous working position was achieved in 17 patients in this group and in 12 cases in the control group (p = 0.088). Conclusions This study confirms that the percutaneous transpedicular screw technique represents a viable option in the treatment of preselected thoracolumbar fractures. A significant reduction in blood loss, postoperative pain, and surgical time were the main advantages associated with this minimally invasive technique. Clinical, functional, and radiological results were at least the same as those achieved using the open technique after a 2-year follow-up. The short-term benefits of the percutaneous transpedicular screw technique are apparent, and long-term results have to be studied in other well-designed studies evaluating the theoretical benefit of the percutaneous technique and assessing whether the results of the latter are as durable as the ones achieved by open surgery.

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Section: Discussionsupporting

confidence: 57%

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

Vaněk

Bradáč

Konopková

et al. 2014

SPI

109

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“…Since Assaker [21] first reported on the application of percutaneous pedicle screw fixation in thoracolumbar trauma, many studies [17,[22][23][24][25][26] were conducted to compare the percutaneous pedicle screw fixation technique with the conventional open approach, which showed that the clinical, functional, and radiological outcomes of the minimally invasive technique were the same as those achieved using the open technique, with a significant reduction in blood loss, post-operative pain, and surgical time. A systematic review and meta-analysis of comparative studies [27] on the percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures showed that there was no difference in efficacy between percutaneous versus open pedicle screw fixation techniques, but the percutaneous approach was associated with shorter surgical time and hospital stay, less intraoperative blood loss and infection rate.…”

Section: Discussionmentioning

confidence: 99%

Effect of the percutaneous pedicle screw fixation at the fractured vertebra on the treatment of thoracolumbar fractures

Zhong

Ren

et al. 2016

International Orthopaedics (SICOT)

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“…Percutaneous pedicle screw fixation systems were originally in the realm of degenerative spinal disease, and have been shown to be effective in avoiding tissue and muscle disruption, whilst shortening hospital and recovery duration, reducing blood loss and complications [17,18]. Whilst similar advantages have also been shown for treatment of thoracolumbar fractures in some reports, the evidence is mainly limited to low-grade, inadequately powered observational studies [3,14,27,31]. Furthermore, long-term outcomes of percutaneous pedicle screw fixation for thoracolumbar fractures has not been well established, further limiting the evidence available for this technology.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies

Phan

Rao

Mobbs

2015

Clinical Neurology and Neurosurgery

145

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Comparison of a Paraspinal Approach with a Percutaneous Approach in the Treatment of Thoracolumbar Burst Fractures with Posterior Ligamentous Complex Injury: A Prospective Randomized Controlled Trial

Abstract: The minimally invasive percutaneous approach appears to be better in cases of successful postural reduction. The paraspinal approach results in better surgical correction and is, therefore, recommended for patients without successful postural reduction.

Cited by 78 publications

References 33 publications

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

Effect of the percutaneous pedicle screw fixation at the fractured vertebra on the treatment of thoracolumbar fractures

Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies

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