Retrospective Analysis of Three Posterior Open Surgical Approaches for the Intraoperative and Long-term Outcomes in the Treatment of Thoracolumbar Burst Fractures

Abstract

Abstract Objective Evaluating the Intraoperative and Long-term Clinical Outcomes of Three Posterior Open Surgical Approaches for the Treatment of Thoracolumbar Burst Fractures. Methods Follow-up observation of 145 patients with thoracolumbar burst fractures treated with three surgical approaches, including “traditional transpedicular four-screw fixation spanning the injured vertebral body (TFSV) (n=38), short-segment transpedicular four-screw fixation through the injured vertebral body (SFTV) (n=53), and six-screw fixation (STV) (n=54)”, at our institution from June 2014 to June 2022. Comparative analysis of perioperative parameters (operative time, intraoperative blood loss, postoperative 24-hour drainage), preoperative and postoperative radiological indices (sagittal plane Cobb angle, Vertebral wedge deformity index), postoperative functional recovery (VAS score, ODI score), and incidence of complications. Results There was no significant difference in general data among the three groups. The SFTV group is superior to the other two groups in perioperative parameters (P＜0.001, P=0.023, P＜0.001). There was significant difference in sagittal plane Cobb angle at each time point among the three groups (P=0.025), but no significant difference in Vertebral wedge deformity index (P=0.299). The improvement of sagittal plane Cobb angle was slightly worse in the group of SFTV. The VAS and ODI scores before and after surgery in each group showed significant improvement (P＜0.001, P＜0.001); however, there were no statistically significant differences between the groups at the same time points (P=0.312, P=0.924). The incisions of all the patients healed at the first stage without any complications. At the end of follow-up, the Cobb angle increased more than 10 degrees in 3 cases (16.67%) in the TFSV group and in 1 case (5.56%) in the SFTV group. Conclusion The treatment of thoracolumbar burst fracture with STV or SFTV is superior to the TFSV, SFTV is better than STV, but the indication of SFTV is limited.