Short Segment Pedicle Screw Fixation for Thoracolumbar Burst Fractures. Percutaneous without Fusion Versus Open Pedicle Screw Fixation with Posterolateral Fusion

Abstract

Background: Fixation of thoracolumbar burst fractures (TLBF) with short segment pedicle screw construct has become popular over last few decades. Spine surgeons have started to deal advanced degenerative spinal pathologies with percutaneous pedicle screw fixation (PPSF) as well. Short segment PPSF has been demonstrated to be an effective treatment option for TLBF fixation in fewer studies so far. This study compared the short segment open pedicle screw fixation (OPSF) with fusion to a short segment PPSF without fusion in the management of TLBF. Methods: Between December 2019 and October 2021, fifty nine patients underwent short-segment pedicle screw fixation, 32 PPSF while 27 OPSF for TLBF. Each of the three follow-up examinations included radiographs to ensure that the spinal column had recovered to its pre-injury state. A lateral thoracolumbar radiograph was used to calculate the Cobb angle, vertebral wedge angle, and vertebral body compression ratio. In this study, patients' pain and function were assessed using the VAS, the Frankel grading system, and the Low Back Outcome Score (LBOS). Additionally, the volume of blood loss and the time required to finish the procedure were also noted. Results: Regional Cobb angle improved post operatively in both groups without any disparity when assessed the two groups, which was noticed till three months. Operative time and blood loss was less in PPSF. LBOS and VAS markedly improved during early follow ups in PPSF group compare to OPSF. Concluding follow up did not show significant difference between PPSF and OPSF. Conclusions: Open or percutaneous short-segment pedicle fixation with or without fusion is secure and efficient treatment option for TLBF. PPSF alone resulted in a greater reduction in pain and improvement in functional ability than the OPSF during initial time period which substantially improve overall outcome in management of TLBF.