A comparison of mini-invasive percutaneous versus classic open pedicle screw fixation of thoracolumbar fractures - retrospective analysis
Abstract
Evaluation of pedicular screw insertion precision, Cobb's angle, vertebral body angulation (VBA), vertebral body index (VBI), duration of surgery and X-ray exposure time in clas sic open and mini-invasive percutaneous stabilisation of traumatic vertebral fractures of the middle and lower thoracic and lumbar spine. Patients and methods: Retrospective analysis of patients who suff ered from traumatic vertebral fractures of the middle and lower thoracic and lumbar spine.
Patients were operated on by clas sic open posterior stabilisation (OPEN group) or by mini-invasive percutaneous posterior stabilisation (MIS group) with insertion of pedicular screws. In this study, patients with traumatic T8- L5 vertebral fracture(s) who had postoperative CT scans dur ing January 1 2015-January 1 2018 were included.
Pedicular screw position was evaluated on axial planes of the postoperative CT scan and classified us ing the modified Gertzbein's grad ing scale. Furthermore, parameters of the kyphosis (Cobb's angle, VBA and VBI) of the involved region were calculated and compared preand postoperatively.
Final ly, us ing patients' charts the duration of surgery and X-ray exposure time and Kerma-Area Product were compared. Results: Dur ing 2015- 2018, a total of 147 patients were included in the study.
The MIS group had 47 patients, and the OPEN group had 100 patients. Cor rect pedicular screw position was achieved in 93.1% in the MIS group and in 94.4% in the OPEN group.
We found no signifi cant diff erence in Cobb's angle, VBI and VBA between the groups. Duration of surgery was signifi cantly shorter in the MIS group - 91 vs. 103 min.
X-ray exposure time was signifi cantly longer in the MIS group - 45 vs. 33 s. We had a 2% infection rate in the OPEN group, but we did not record any such complications in the MIS group.
Conclusions: The total number of pedicular screw malpositions in our study did not diff er signifi cantly between the groups. We registered a higher number of grade 3A pedicular screw malpositions (medial pedicle breach > 4 m m) accord ing to the modified Gertzbein's grad ing scale lead ing to a higher number of reoperations in the MIS group.
However, this was likely due to learn ing curve is sues. In the OPEN group, the duration of surgery was signifi cantly longer in the OPEN group; on the other hand, X-ray exposure time was signifi cantly shorter.
There were no infectious complications in the MIS group.