330 Outcome of Percutaneous Versus Open Posterior Spinal Fixation in Thoracolumbar Fractures.
Neurosurgery. 2016 Aug;63 Suppl 1, CLINICAL NEUROSURGERY:196
Authors: Elsawaf AM
INTRODUCTION: Unstable thoracolumbar fractures are usually managed by posterior instrumentation. The standard open pedicle screw fixation or the newly introduced percutaneous technique can be used. The purpose of this study is to provide safety and feasibility of both techniques and getting a more obvious plan for choosing either of them in such cases.
METHODS: In a prospective study of a total of 166 patients with unstable thoracolumbar fractures with a mean follow-up of 14 months (range 10-21), the patients were classified randomly into 2 groups: Group I: patients who underwent percutaneous spinal fixation and minimally invasive decompression if needed (72 patients). Group II: patients who underwent standard open pedicle screw fixation with open decompression (94 patients). All patients had complete clinical assessments with the use of the Frankle grading scale and the visual analog scale (VAS) for assessment of fracture site pain. We had also neuroradiographic assessment (anteroposterior x-ray, thin cuts CT scan, and MRI imaging) at the first presentation and at 3, 6, and 12 months later.
RESULTS: Immediately after surgery, the percutaneous approach had significantly better results than open procedures in respect to operative time, hospital stay, and postoperative pain. At the final follow-up; 87.5% of the percutaneous group showed either completely normal or neurological improvement according to Frankle grade. However, 89.5% in group II showed similar results. Regarding screw position, the open group had only 75% satisfactory position; however, 83% of screws inserted showed satisfactory position in the percutaneous technique, the Cobb angle, and degree of canal encroachment also assessed, respectively.
CONCLUSION: Percutaneous technique in stabilizing the thoracolumbar fractures could be done regularly in all cases with percutaneous minimally invasive decompression if needed. Open spinal fixation can be reserved for those with significant canal compromise, especially if multilevel decompression is required.
PMID: 27399528 [PubMed – as supplied by publisher]