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Usefulness of Percutaneous Pedicle Screw Fixation for Treatment of Lower Lumbar Burst (A3-A4) Fractures: Comparative Study with Thoracolumbar Junction Fractures

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Abstract

Background

Percutaneous pedicle screw fixation (PPSF) without fusion has been recently recommended in the treatment of thoracolumbar fracture to reduce the adverse effects associated with the conventional open approaches and to restore range of motion. However, those studies report on the thoracolumbar junction, and there is no report on lower lumbar fracture.

Purpose

To assess effectiveness of PPSF without fusion for treating lower lumbar burst (A3 and A4) fractures.

Methods

A retrospective analysis was made to evaluate consecutive 50 patients with AO type A3 and A4 thoracolumbar fracture underwent PPSF. Patients were divided into a thoracolumbar junction (TLJ) group (T11-L2) and lower lumbar (LL) group (L3-5). The following items were measured and compared between the two groups. Vertebral height and consolidation, retropulsed fragment, sagittal curve and fixation failure were assessed with certain interval regularly.

Results

The average height at pre- and post-reduction were 56.2% (36.2–74.3), 95.3% (84.2–98.3) in TLJ group and 65.7% (45.7–86.2), 91% (73.1–100) in LL group. The average canal area occupancy rate at pre- and post-reduction were 46.1% (37.4%–67.5%), 38.1% (31.3%–40.8%) in TLJ group and 40.4% (15.0–65.7), 19.3% (9.4–26.6) in LL group. Consolidation was completed within 12 months after surgery in both groups. There was no significant difference between two groups in clinical and radiographic parameters except cobb angle loss.

Conclusion

Patients with lower lumbar fracture can be effectively managed with PPSF without fusion. PPSF following the implant removal can restore the movement of the lower lumbar spine, which is essential for daily life.

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Data availability

The data are not publicly available due to their containing information that could compromise the privacy of research participants.

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Funding

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. This study was approved by the ethical committee of the hospital.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Myung-Sang Moon

  2. Department of Orthopedic Surgery, Cheju Halla General Hospital, Jeju, Republic of Korea

    Chang Geun Yu

  3. Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, 51353, Republic of Korea

    Jong Min Jeon & Seung Myung Wi

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Correspondence to Seung Myung Wi.

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Moon, MS., Yu, C.G., Jeon, J.M. et al. Usefulness of Percutaneous Pedicle Screw Fixation for Treatment of Lower Lumbar Burst (A3-A4) Fractures: Comparative Study with Thoracolumbar Junction Fractures. JOIO 57, 1415–1422 (2023). https://doi.org/10.1007/s43465-023-00911-9

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