Therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures.</p><p><b>METHODS</b>From January 2002 to December 2008, 103 patients with thoracolumbar fractures were treated with percutaneous pedicle screw fixation, including 75 males and 28 females, the average age was 45.6 years (range, 18 - 72 years). All of them were of no neurological deficits. There were 65 cases of traffic injury, 23 cases of fall injury and 15 cases of smashed injury. According to the Denis classification, 64 patients were of compression fractures, and 39 patients of burst fractures. There were 5 cases had fractures in T(11), 30 in T(12), 42 in L(1), 15 in L(2), 4 in L(3), 3 in L(4), 2 in T(11-12), 1 in L(1-2), and 1 in L(2-3). Radiological examinations, including X-ray and CT examinations, and clinical examinations were carried out to evaluate the therapeutic effects.</p><p><b>RESULTS</b>Twenty one patients were lost to follow up, the remaining were followed up from 10 to 48 months with an average of 27.4 months. Before the operation, the vertebral height, the kyphosis angle and the occupation of spinal canal were (54.5 ± 8.7)%, 16.4° ± 2.9° and 1.2 ± 1.0, and were improved to (88.6 ± 6.4)%, 11.6° ± 2.7° and 0.5 ± 0.6 respectively after the operation. Preoperatively the visual analogue scale and the Oswestry disability index were 8.0 ± 1.2 and 41.2 ± 9.3, and were improved to 1.7 ± 1.8 and 6.7 ± 5.6 postoperatively, respectively. All of these values between pre- and post-operatively were significantly different (P < 0.01). Screw misplacement was found in 7 patients, superficial wound infection in 1, screw breakage in 3, screw dislodgment in 2, cement leakage in 5, transient neurological symptoms in 4, and 8 patients with low back pain remained, of which 2 patients required occasional oral analgesics. Bone fusion achieved in all cases.</p><p><b>CONCLUSIONS</b>The clinical efficacy of percutaneous pedicle screw fixation is similar with conventional open surgery. With the advantages of convenient procedure, less invasive, and rapid recovery, percutaneous pedicle screw fixation is an alternative method for thoracolumbar fractures without neurological deficits.</p>