Comparison of Percutaneous and Open Posterior Spinal Fixation in Thoracolumbar Fractures

Background: Unstable thoracolumbar fractures are usually managed by posterior instrumentation. The standard open pedicle screw fixation or the newly introduced percutaneous technique can be used. Objectives: The purpose of this study was to provide safety and feasibility of both techniques and getting a more obvious plan for choosing either of them in such cases. Methods: This is a prospective study of a total of hundred and sixty-six patients with unstable thoracolumbar fractures with a mean follow-up of 14 months (range 10-21), they were classified randomly into two groups: Group I: Patients who underwent percutaneous spinal fixation and minimally invasive decompression if needed (72 patients). Group II: Patients who underwent standard open pedicle screw fixation with open decompression (94 patients). All patients had complete clinical assessments using Frankle grading scale and the visual analogue scale (VAS) for assessment of fracture site pain. We had also neuro-radiographic assessment (Antero-posterior X-ray, thin cuts CT scan and MRI imaging) at the first presentation and at 3, 6 and 12 months later. Results: Immediately after surgery, percutaneous approach had a significantly better results compared to open procedures in respect to operative time, hospital stay, and postoperative pain. At the final follow-up, there was significant clinical and radiological improvement according to Frankle grading scale in both groups. The Cobb angle and degree of canal encroachment also assessed respectively. Conclusion: Percutaneous technique in stabilizing the thoracolumbar fractures could be done regularly in all cases with percutaneous minimally invasive decompression if needed. Open spinal fixation can be reserved for significant canal compromise especially if multilevel decompression is required.