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Percutaneous pedicle screw fixation without arthrodesis of 368 thoracolumbar fractures: long-term clinical and radiological outcomes in a single institution

Abstract

Purpose

Traumatic thoracolumbar (TL) fractures are the most common vertebral fractures. Although a consensus on the preferred treatment is missing, percutaneous pedicle screw fixation (PPSF) has been progressively accepted as treatment option, since it is related to lower soft tissues surgical-injury and perioperative complications rate. This study aims to evaluate the long-term clinical–radiological outcomes after PPSF for TL fractures at a single tertiary academic hospital.

Methods

This is a retrospective cohort study. Back pain was obtained at preoperative, postoperative and final follow-up using Visual Analog Scale. Patient-reported outcomes, the Oswestry Disability Index and the 36-Item Short Form, were obtained to asses disability during follow-up. Radiological measures included Cobb angle, mid-sagittal index, sagittal index (SI) and vertebral body height loss. A multivariate regression analysis on preoperative radiological features was performed to investigate independent risk factors for implant failure.

Results

A total of 296 patients with 368 TL fractures met inclusion criteria. Mean follow-up was 124.3 months. The clinical and radiological parameters significantly improved from preoperative to last follow-up measurements. The multivariate analysis showed that Cobb angle (OR = 1.3, p < 0.001), SI (OR = 1.5, p < 0.001) and number of fractures (OR = 1.1, p = 0.05), were independent risk factors for implant failure. The overall complication rate was 5.1%, while the reoperation rate for implant failure was 3.4%.

Conclusions

In our case series, PPSF for TL injuries demonstrated good long-term clinical-radiological outcomes, along with low complication and reoperation rates. Accordingly, PPSF could be considered as a valuable treatment option for neurologically intact patients with TL fractures. Additionally, in this cohort, number of fractures ≥ 2, Cobb angle ≥ 15° and sagittal index ≥ 21° were independent risk factors for implant failure.

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Fig. 1

Abbreviations

TL:

Thoracolumbar

PPSF:

Percutaneous pedicle screw fixation

CT:

Computed tomography

MIS:

Minimally invasive surgery

MSI:

Mid-sagittal index

MRI:

Magnetic resonance imaging

ODI:

Oswestry Disability Index

PLC:

Posterior ligamentous complex

SI:

Sagittal index

VAS:

Visual analog scale

VBHL:

Vertebral body height loss

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Correspondence to Sokol Trungu.

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Trungu, S., Ricciardi, L., Forcato, S. et al. Percutaneous pedicle screw fixation without arthrodesis of 368 thoracolumbar fractures: long-term clinical and radiological outcomes in a single institution. Eur Spine J (2022). https://doi.org/10.1007/s00586-022-07339-z

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  • DOI: https://doi.org/10.1007/s00586-022-07339-z

Keywords

  • Thoracolumbar fracture
  • Percutaneous pedicle screw fixation
  • Burst fracture
  • Minimally invasive surgery
  • Posterior short-segment fixation