International Orthopaedics

, Volume 43, Issue 7, pp 1749–1754 | Cite as

Comparison of clinical results between novel percutaneous pedicle screw and traditional open pedicle screw fixation for thoracolumbar fractures without neurological deficit

  • Ming Yang
  • Qinpeng Zhao
  • Dingjun Hao
  • Zhen Chang
  • Shichang LiuEmail author
  • Xinhua YinEmail author
Original Paper



To compare the efficacy and safety of novel percutaneous minimally invasive pedicle screw fixation and traditional open surgery for thoracolumbar fractures without neurological deficit.


Sixty adult patients with single thoracolumbar fracture between June 2014 and June 2016 were recruited in this study, randomly divided into open fixation group (group A) or minimally invasive percutaneous fixation group (group B). Clinical and surgical evaluation including surgery time, blood losses, radiation times, hospital stay, and complication were performed. The two groups of patients with pre-operative and last follow-up anterior height ratio of fracture vertebral, Cobb angle of fracture vertebral, and VAS score of back pain were compared.


All patients completed valid follow-ups, with an average time period of 15.4 months (12–26 months). Group B achieved much better results in time of operation, intra-operative blood loss, and length of stay than group A (P < 0.05). Group A was significantly better than group B in the times of radiation (P < 0.05). The VAS score was significantly lower in group B than in group A at three days after the operation (P < 0.05). There were no significant differences between the two groups in the anterior height ratio of fracture vertebral, Cobb angle, and VAS score in the last follow-up (P > 0.05). No injured nerve or other severe complications occurred in both groups; one of the patients from group A had back and loin pain lasting for about one month, which resolved after analgesia and functional training. There was no significant difference between the two groups in incidence of complications.


Novel percutaneous pedicle screws with angle reset function can achieve the same effect as traditional open pedicle screw fixation in the treatment of thoracolumbar fractures without nerve injuries. Percutaneous minimally invasive pedicle screw fixation has the characteristics of shorter operative time, less bleeding, and less pain, but it needs more radiation times.


Percutaneous Minimally invasive Pedicle screw Thoracolumbar fracture Internal fixation 


Compliance with ethical standards

The Ethics Committee in Xi’an Jiaotong University approved the study.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Hu R, Mustard CA, Burns C (1996) Epidemiology of incident spinal fracture in a complete population. Spine (Phila Pa 1976) 21(4):492–499CrossRefGoogle Scholar
  2. 2.
    Shen WJ, Shen YS (1999) Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976) 24(4):412–415CrossRefGoogle Scholar
  3. 3.
    Weinstein JN, Collalto P, Lehmann TR (1988) Thoracolumbar “burst” fractures treated conservatively: a long-term follow-up. Spine (Phila Pa 1976) 13(1):33–38CrossRefGoogle Scholar
  4. 4.
    Vanek P, Bradac O, Konopkova R et al (2014) Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up. J Neurosurg Spine 20(2):150–156CrossRefGoogle Scholar
  5. 5.
    Ringel F, Stoffel M, Stuer C et al (2006) Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine. Neurosurgery 59(4 Suppl 2):ONS361–ONS366 discussion ONS6–7Google Scholar
  6. 6.
    Kim DY, Lee SH, Chung SK et al (2005) Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976) 30(1):123–129CrossRefGoogle Scholar
  7. 7.
    Magerl FP (1984) Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res 189(189):125–141Google Scholar
  8. 8.
    Koreckij K, Park DK, Fischgrund J (2014) Minimally invasive spine surgery in the treatment of thoracolumbar and lumbar spine trauma. Neurosurg Focus 37(1):E11CrossRefGoogle Scholar
  9. 9.
    Mobbs RJ, Sivabalan P, Li J (2011) Technique, challenges and indications for percutaneous pedicle screw fixation. J Clin Neurosci 18(6):741–749CrossRefGoogle Scholar
  10. 10.
    Butt MF, Farooq M, Mir B et al (2007) Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation. Int Orthop 31(2):259–264CrossRefGoogle Scholar
  11. 11.
    Singh R, Rohilla RK, Kamboj K et al (2014) Outcome of pedicle screw fixation and monosegmental fusion in patients with fresh thoracolumbar fractures. Asian Spine J 8(3):298–308CrossRefGoogle Scholar
  12. 12.
    Bolesta MJ, Caron T, Chinthakunta SR et al (2012) Pedicle screw instrumentation of thoracolumbar burst fractures: biomechanical evaluation of screw configuration with pedicle screws at the level of the fracture. Int J Spine Surg 6(1):200–205CrossRefGoogle Scholar
  13. 13.
    Charles YP, Walter A, Schuller S et al (2012) Thoracolumbar fracture reduction by percutaneous in situ contouring. Eur Spine J 21(11):2214–2221CrossRefGoogle Scholar
  14. 14.
    Kim BG, Dan JM, Shin DE (2015) Treatment of thoracolumbar fracture. Asian Spine J 9(1):133–146CrossRefGoogle Scholar
  15. 15.
    Scheufler K M, Dohmen H, Vougioukas V I (2007) Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery, 60(4 Suppl 2): 203-212; discussion 212-3Google Scholar
  16. 16.
    Ni WF, Huang YX, Chi YL et al (2010) Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. J Spinal Disord Tech 23(8):530–537CrossRefGoogle Scholar
  17. 17.
    Wang HW, Li CQ, Zhou Y et al (2010) Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using sextant system: an analysis of 38 cases. Chin J Traumatol 13(3):137–145Google Scholar
  18. 18.
    Raley DA, Mobbs RJ (2012) Retrospective computed tomography scan analysis of percutaneously inserted pedicle screws for posterior transpedicular stabilization of the thoracic and lumbar spine: accuracy and complication rates. Spine (Phila Pa 1976) 37(12):1092–1100CrossRefGoogle Scholar
  19. 19.
    Wiesner L, Kothe R, Schulitz KP et al (2000) Clinical evaluation and computed tomography scan analysis of screw tracts after percutaneous insertion of pedicle screws in the lumbar spine. Spine (Phila Pa 1976) 25(5):615–621CrossRefGoogle Scholar
  20. 20.
    Wang X, Aubin CE, Crandall D et al (2012) Biomechanical analysis of 4 types of pedicle screws for scoliotic spine instrumentation. Spine (Phila Pa 1976) 37(14):E823–E835CrossRefGoogle Scholar
  21. 21.
    Wang X, Aubin CE, Crandall D et al (2011) Biomechanical comparison of force levels in spinal instrumentation using monoaxial versus multi degree of freedom postloading pedicle screws. Spine (Phila Pa 1976) 36(2):E95–E104CrossRefGoogle Scholar
  22. 22.
    Yuan C, Chen K, Zhang H et al (2014) Unilateral versus bilateral pedicle screw fixation in lumbar interbody fusion: a meta-analysis of complication and fusion rate. Clin Neurol Neurosurg 117:28–32CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Spinal Surgery, Hong Hui HospitalXi’an Jiaotong University College of MedicineXi’anChina

Personalised recommendations