Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture

Abstract

Abstract Background Evaluate the feasibility, safety, efficacy, and indications of percutaneous pedicle screw fixation (PPSF) combined with selective transforaminal endoscopic decompression (TED) in the treatment of thoracolumbar burst fracture (TLBF). Methods From August 2015 to August 2020, a total of 54 patients with single-segment TLBF enrolled in this study, of which 36 underwent PPSF alone and 18 underwent TED after PPSF. X-ray and computed tomography were performed before and 1 week after operation. Cobb angle(CA), vertebral wedge angle(VWA), vertebral body compression ratio(VBCR) and mid-sagittal canal diameter compression ratio(MSDCR)were calculated to evaluate the effect of spinal reduction. we used visual analogue scale(VAS), the Oswestry Disability Index(ODI), the Japanese Orthopedic Association score (JOA), and the Frankel Classification of Neurological Deficits to evaluate the effectiveness of surgical treatment before surgery, 1 week, 12 months and 36 months after surgery. Results All patients were followed up for 36 months. The decompression group had a higher VBCR and MSDCR than the non-decompression group before surgery. The CA, VBCR, VWA and MSDCR in the two groups were significantly improved compared with those before operation. The VAS, ODI, JOA and Frankel grades of the two groups were significantly improved after operation, and the curative effect was good after 12 months and 36 months of follow-up. Conclusions PPSF combined with selective TED in the treatment of TLBF had excellent efficacy, high safety, less injury, and a wide range of indications, which could accurately distinguish patients who did not need spinal canal decompression after posterior fixation.