Comparison Of Efficacy Of Three Types Of Pedicle Screw Fixation For Thoracolumbar Fractures

Objective To compare the short-term effects and efficacy of traditional posterior pedicle screw fixation,Wiltse paraspinal approach with pedicle screw fixation and percutaneous pedicle screw fixation for the treatment of thoracolumbar fractures.Methods Retrospective analysis was performed on 59 patients who underwent traditional posterior pedicle screw fixation,paraspinal approach and percutaneous pedicle screw fixation for thoracolumbar fractures without spinal nerve injury in the Department of Spine Surgery,Hangzhou First People’s Hospital between January 2018 and December 2019,including 20 patients in the posterior approach group,19 patients in the paraspinal approach group and 20 patients in the percutaneous approach group.The length of surgical incision,operative time,intraoperative bleeding and postoperative hospital stay;changes in leucocyte count,CRP and serum creatine kinase levels;visual analogue score of low back pain and scale of activities of daily living;and whether there were complications such as wound infection and nerve injury;and radiographic parameters such as the recovery of vertebral height and kyphotic Cobb angle in the three groups were compared preoperatively and postoperatively.Results A total of 20 patients(13 males and 7 females,age 47.55±7.99 years)in the posterior approach group,19 patients(12 males and 7 females,age 48.37±9.82 years)in the paraspinal approach group and 20 patients(14 males and 6 females,age 45.1±11.87 years)in the percutaneous approach group were included.There was no significant difference between the three groups in terms of time to surgery,time from admission to surgery and time from surgery to discharge(p>0.05).The length of the surgical incision in the percutaneous approach group(7.80±0.95 cm)was significantly less than that in the posterior approach group(10.70±1.59 cm)and the paraspinal approach group(10.05±1.13 cm),and the intraoperative bleeding(72.50±21.31 ml)was less than that in the posterior median approach group(156.25±26.75ml)and the paraspinal approach group(128.95±25.36 ml).There was no significant difference in leukocyte count and CRP between the three groups(p>0.05),except that the CRP was lower in the paraspinal approach than in the other two groups at 7 days postoperatively(p<0.05).Creatine kinase levels in the posterior group were higher than in both minimally invasive groups at 1,3 and 7 days postoperatively(p<0.05).There were no significant differences in the vertebral height and kyphotic Cobb angle of the injured spine between the 3 groups at preoperative,7 days postoperative,3 months postoperative and 6 months postoperative(p>0.05).Postoperative ADL scores and VAS scores improved significantly in all three groups compared to preoperative scores(p<0.05),and pain and functional scores were better in the percutaneous access group than in the remaining two groups.Conclusion All three types of pedicle screw placement are effective methods for the treatment of thoracolumbar fractures.The paraspinal approach avoids stripping of the paravertebral muscles,causes less damage to the paravertebral soft tissues,has a low creatine kinase level and less intraoperative bleeding;percutaneous approach has the advantages of simple surgical access,minimally invasive incision length and less bleeding,and can achieve similar functional recovery as traditional posterior pedicle screw fixation surgery,with early recovery of pain and function,and there was no significant difference in vertebral body height and posterior convexity Cobb recovery compared to the two surgical approaches(p>0.05).