RESUMEN
BACKGROUND: Despite a long history of descriptive and clinical series, there is still no consensus in the treatment of traumatic thoracolumbar fractures. It is now widely accepted that percutaneous surgery in thoracolumbar spine trauma management can achieve the same results as conventional treatment but less morbidity but it is still not clear which are the best indications for these minimal invasive procedures. METHODS: Thirty-two adult patients with single type A3 thoracolumbar burst fractures without neurologic deficits were included in this retrospective review of clinical and radiological outcomes after surgical management. All patients underwent combined percutaneous kyphoplasty and short fixation with screws in the vertebral pedicles above and below the fracture. Radiographic evaluation of segmental kyphosis and local kyphotic corrections were made preoperatively, 3 days postoperatively, 12 months post-operatively and at the last follow-up (the mean last follow-up was 41 months post-operatively). Clinical outcomes were determined by SF-36® Health Survey and Oswestry Disability Index scores at 3-month and 12-month follow-ups. RESULTS: Clinical assessments suggested good outcomes as early as the third postoperative month. The clinical outcomes were sustained at one year follow-up. At the last follow-up the segmental kyphosis correction and local kyphotic correction were maintained. CONCLUSIONS: Our analysis demonstrates that minimally invasive kyphoplasty and percutaneous short fixation applied to thoracolumbar A3 burst fractures without neurological deficit may achieve results comparable to nonsurgical or open surgical treatment, but with less morbidity and complication, and should be considered as a valid treatment option.
RESUMEN
PURPOSE: To assess and compare the efficacy of two minimally invasive techniques (percutaneous pedicle screw with intermediate screw vs. percutaneous pedicle screw with kyphoplasty) for spinal fracture fixation by comparing the segmental kyphosis and vertebral kyphosis angles after trauma before surgery, after surgery, and at 4-month and 12-month follow-up. METHODS: Data from 49 patients without neurological deficit treated by either percutaneous pedicle screw with intermediate screw or percutaneous pedicle screw with kyphoplasty were retrospectively analysed. The segmental kyphosis and vertebral kyphosis angles over time were calculated and correlated with the type of procedure, AO classification, lumbar or thoracic site and the age and sex of the patients. RESULTS: After surgery, both techniques were found to be efficacious means of bringing about a significant correction of the segmental kyphosis angle (p = 0.002) and a just significant correction of the vertebral kyphosis angle (p = 0.06), although less effectively in thoracic fractures (p = 0.004). At follow-up, the vertebral kyphosis angle was stable in both groups, while there was a significant loss of segmental kyphosis angle stability in the percutaneous pedicle screw with kyphoplasty group at 1 year (p = 0.004); fractured thoracic vertebrae maintained a greater vertebral kyphosis angle (p = 0.06) and segmental kyphosis angle (p < 0.001), than the lumbar. CONCLUSION: At 1 year after surgery, the use of intermediate screws in fractured vertebrae seemed to maintain a more efficacious correction with respect to kyphoplasty, although thoracic fracture sites appear to be associated with greater post-traumatic segmental kyphosis and lesser stability in the long term after both percutaneous surgical techniques.
