ABSTRACT

Objective:

To present the short-term results of 24 patients treated by percutaneous pedicle screw fixation for traumatic thoracolumbar fractures, compared to 24 matched patients treated by open pedicle screw fixation.

Summary of Background Data:

Although pedicle screw implants provide quick and reliable stabilization, extensive soft tissue dissection is necessary. Screws inserted percutaneously may reduce surgical trauma.

Materials and Methods:

A total of 24 patients from the percutaneous pedicle screw group (PPSG) were compared to 24 matched patients treated in the open pedicle screw group (OPSG). Both types of screws were inserted with a freehand technique. The parameters compared were operation time, blood loss, duration of hospital stay and complications.

Results:

Both groups consisted of 58% males; the mean age was 48.7 years in the PPSG and 47.1 years in the OPSG. The groups were not statistically different. The mean follow-up period was 14.0 months (PPSG) and 17.3 months (OPSG). In both groups, most of the fractures were type B injuries (flexion/ distraction/extension according to the AO classification) without neurological deficit. A significant difference in median blood loss was found (50 mL in the PPSG; 500 mL in the OPSG; p<0.001). The operation duration in the PPSG was 103.2 ± 24.6 (68–169) minutes, in the OPSG it was 142.0 ± 45.4 (95– 270) minutes (p<0.001). Three malpositioned screws and one dural perforation occurred in the PPSG, and one malpositioned screw with a dural tear occurred in the OPSG. Five deep infections developed in the OPSG, all requiring surgical debridement. The postoperative hospital stay was 12.7 ± 9.3 days for the PPSG and 17.7 ± 14.5 days for the OSPG (not significant). During follow-up, loss of correction occurred five times in the PPSG, and three times in the OPSG.

Conclusion:

Using percutaneous pedicle screw fixation resulted in less blood loss, shorter surgical duration and a lower number of infections compared to the open technique. Percutaneous pedicle screw fixation is a promising technique to stabilize traumatic spine fractures in selected cases.