Comparison Study Between Paraspinal Approach And Conventional Approach For Thoracolumbar Vertebral Fracture

Objective To determine the difference of clinical outcome and paraspinal muscle injurebetween paraspinal approach and conventional approach for the thoracolumbarfractures.Methods Prospective comparison study was conducted，From June2010to June2012,a total of45patients, who suffered from thoracolumbar fractures withneurological intact（ASIA5）,underwent surgical treatment. Randomly，21patientsadopted paraspinal approach, including15males and6females, with an average age of(36.5±11.5)years, comprised5compression fractures and16burst fractures,Accordingto the injured location,1T11fractures，4T12fractures,12L1fractures, and4L2fractures were involved. The other24cases underwent the traditional procedure,including16males and8females, with an average age of (37.6±7.8))years, comprised6compression fractures and18burst fractures,According to the injured location,2T11fractures，3T12fractures,15L1fractures, and4L2fractures were involved. Outcomemeasure:Operative time,Blood loss,Postoperative drainage CK, kyphosis degree, VASscore preoperatively1and2days postoperatively.All patients were followed up，multifidus muscle EMG were adopted for evaluation,also Japanese OrthopaedicAssociation (JOA)score of back pain were analyzed Postoperative6months.Results All patients were follow-up from6to12months with an average of8months.No postoperative infection,secondary spinal cord injury, internal fixation breakage wasfound.There was no obvious difference in The Cobb’s angle restoration, but paraspinalapproach had obvious advantages in blood loss,volume of drainage,operation time，visual analogue scale (VAS)score and the index of serum level of Creatinine Kinase.The Japanese Orthopaedic Association(JOA) score of back pain postoperativein paraspinal approach was less than in conventional open approach grouppostoperatively but the difference was not statistically significant.compare to theconventional approach group. paraspinal approach group EMGs also has littlefibrillation potentials,the difference was statistically significant(p<0.05).Conclusions In the premise of strict controlling surgery indications,the treatment ofthoracolumbar with paraspinal approach can acuire satisfactory clinical results,but muchless invasive, blood loss and operation time,accelerate the rehabilitation simultaneously.