2022, Vol. 26 ›› Issue (36): 5844-5848

Three approaches of pedicle screw internal fixation for thoracolumbar fractures: spinal function, vertebral height reduction and local Cobb angle recovery

Song Dawei, Yu Hao, Yang Ming, Xie Haifeng, Wu Cenhao, Yan Qi, Wang Yingjie, Yang Huilin, Geng Dechun, Niu Junjie, Wang Jinning   

Abstract: BACKGROUND: Pedicle screw internal fixation is one of the main first choices for the treatment of thoracolumbar fractures. The therapeutic effects of percutaneous pedicle screw, Wiltse approach, and conventional approach remain in controversy.
OBJECTIVE: To evaluate the clinical effects of percutaneous pedicle screw, Wiltse approach, and conventional approach in the treatment of thoracolumbar fractures.
METHODS: A retrospective analysis of the medical records of patients with thoracolumbar fractures admitted to First Affiliated Hospital of Soochow University from February 2017 to October 2019 was performed. A total of 46 cases were enrolled and all received pedicle screw internal fixation, of which 15 cases received percutaneous screw placement, 17 cases through the Wiltse approach, and 14 cases through the posterior median approach. Serum creatine kinase level, visual analogue scale score, Qswestry dysfunction index, Japanese Orthopaedic Association (JOA) score, the relative height of the anterior edge of the injured vertebrae and the sagittal kyphotic Cobb angle were compared before and after the operation in the three groups.  
RESULTS AND CONCLUSION: (1) All 46 patients underwent surgeries successfully with no complications such as internal fixation breakage. (2) The creatine kinase levels of the three groups 3 days after operation were higher than those before operation (P < 0.05). The level of creatine kinase at 3 days after operation was percutaneous pedicle screw group < Wiltse approach group < posterior median approach group (P < 0.05). (3) The visual analogue scale scores, Qswestry dysfunction index, and JOA scores of the three groups after surgery were significantly improved compared with those before surgery (P < 0.05). At 3 days after operation and the internal fixation removal, the Qswestry dysfunction index and JOA score of the percutaneous pedicle screw group were better than those of the Wiltse approach group and the posterior median approach group (P < 0.05). Qswestry dysfunction index and JOA score were better in the Wiltse approach group than those of the posterior median approach group (P < 0.05). (4) The relative height of the anterior edge of the injured vertebrae and the sagittal kyphotic Cobb angle of the three groups were significantly improved 3 days after operation and after the internal fixation removal compared with those before surgery (P < 0.05). There was no significant difference in the relative height of the anterior edge of the injured vertebrae and the sagittal kyphotic Cobb angle between the three groups after surgery (P > 0.05). (5) These results indicate that the percutaneous pedicle screw and Wiltse approach have little effect on the paravertebral muscles compared with conventional approach, and it is more conducive to the postoperative functional recovery of patients with thoracolumbar fractures.
Key words: thoracolumbar fracture, surgical treatment, pedicle screw, surgical approach, Wiltse approach, posterior median approach, clinical effect