Two Different Minimally Invasive Approaches for Management of Thoracolumbar Fractures

Objective: To compare the clinical effect and safety of pedicle screw fixation via percutaneous approach and Wiltse paraspinal approach for thoracolumbar fractures without neurological deficit. Methods: 98 cases who suffered from single level thoracolumbar fracture without nerve injury were treated by pedicle screws fixation via either percutaneous approach (percutaneous group) and Wiltse paraspinal approach(paraspinal group). Perioperative indexes, imaging parameters and functional and symptom results of the two groups were recorded and compared. Results: All patients were followed for more than 12 months, and the incision length and postoperative hospital stay in the percutaneous group were significantly shorter than those in the paraspinal group (P<0.05), intraoperative blood loss was less than that of the paraspinal group (P<0.05), operative and postoperative costs and the number of fluoroscopy were significantly higher than those of the paraspinal group (P 0.05). The anterior edge height percentage of the injured vertebrae and kyphosis Cobb Angle were significantly improved 1 week and 1 year postoperatively in each group (P<0.05), there was no statistical difference between the two groups (P<0.05). As for Visual Analog Scale (VAS) scores, in each group there were continuous decreases 3 days, 6 months, and 1 year postoperatively (P<0.05); There were no statistically significant differences between the two groups before operation, 6 months and 1 year postoperatively (P<0.05), but a significant difference 3 days postoperatively (P<0.05). In terms of Oswestry disability index (ODI), in each group there was continuous decreases 6 months and 1 year postoperatively (P<0.05); and there was no significant difference between the two groups (P<0.05).There was no significant difference in the accuracy of implant between the two groups (P<0.05). In the percutaneous group, there were 2 cases of incision fat liquefaction, 1 case of guidewire fracture and 1 case of the anterior wall of the vertebra penetrated by guide wire rupture. 1 diabetic case of superficial incision infection and 2 cases of skin edge necrosis were found in the paraspinal group. Conclusion: In the treatment of thoracolumbar fractures without neurological defect, pedicle screw fixations via Wiltse paraspinal and percutaneous approach both can obtain minimally invasive and reliable effect, but the percutaneous approach bring smaller trauma, less blood loss, longer operation time, more fluroscopy, higher surgery and postoperative costs, with its own unique complications especially in early learning curve.