[Percutaneous pedicle screw fixation and minimally invasive decompression in the same incision for type A3 thoracolumbar burst fracture].

Objective: To assess the effectiveness of percutaneous pedicle screw fixation and minimally invasive decompression in the same incision for type A3 thoracolumbar burst fracture.

Methods: Between May 2014 and February 2016, 43 cases of type A3 thoracolumbar burst fracture with or without nerve symptoms were treated with pedicle screw fixation and neural decompression. Of them, 21 patients underwent percutaneous pedicle screw fixation and minimally invasive decompression in the same incision (percutaneous group), and the other 22 patients underwent traditional open surgery (open group). There was no significant difference in gender, age, cause of injury, fractures level, preoperative American Spinal Injury Association (ASIA) grade, thoracolumbar injury classification and severity (TLICS) score, load-sharing classification, height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment between 2 groups ( P >0.05). The length of soft tissue dissection, operation time, intraoperative blood loss, postoperative drainage, X-ray exposure times, and incision visual analogue scale (VAS) score at 1 day after operation were recorded and compared. At last follow-up, Japanese Orthopaedic Association (JOA) score and low back pain VAS score were recorded and compared respectively. The ASIA grade recovery was evaluated; the height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment were assessed postoperatively.

Results: Percutaneous group was significantly better than open group in the length of soft tissue dissection, intraoperative blood loss, postoperative drainage, and incision VAS at 1 day after operation ( P <0.05), but no significant difference was found in operation time between 2 groups ( P >0.05); however, X-ray exposure times of open group were significantly better than that of percutaneous group ( P <0.01). The patients were followed up 12 to 19 months (mean, 15.1 months) in 2 groups. All patients achieved effective decompression. No complications of iatrogenic neurological injury and internal fixation failure occurred. The height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment of the fractured vertebral body were significantly improved at 3 days after operation when compared with preoperative ones ( P <0.05), but no significant difference was found between 2 groups ( P >0.05). At last follow-up, JOA score and low back pain VAS score of percutaneous group were significantly better than those of open group ( P <0.05). The neurological function under grade E was improved at least one ASIA grade in 2 groups, but no significant difference was shown between 2 groups ( Z =0.480, P =0.961).

Conclusion: Percutaneous pedicle screw fixation and minimally invasive decompression in the same incision for type A3 thoracolumbar burst fracture has satisfactory effectiveness. And it has the advantages of minimal trauma, quick recovery, safeness, and reliableness.