Comparison of posterior open screw fixation with percutaneous fixation among traumatic thoracolumbar fracture patients.

Abstract

Objectives: To compare outcome and adverse events of open posterior pedicle screw fixation with percutaneous posterior pedicle screw fixation among patients suffering traumatic thoracolumbar fractures in our population. Study Design: Retrospectively Analyzed. Setting: Department of Neurosurgery, DHQ Teaching hospital, Gujranwala. Period: June 2015 to May 2019. Material & Methods: The patients who underwent open pedicle screw fixation (group 1) and percutaneous fixation (group 2) for traumatic thoracolumbar fractures information’s collected included patient’s age, gender, operation time, intra-operative blood loss, duration of radiation exposure during surgery, hospital stay duration, non-union at 6months and post-operative screw malpositioning and infection. Statistical analysis was done using SPSS version 25. Independent sample T test and Chi-square test for independence were used for quantitative and qualitative variables respectively to determine their significant association with type of surgery. The p values were statistically significant if < 0.05. Results: Out of 82 patients, 60.9 (n=50) underwent open pedicle screw surgery and 39.1% (n=32) underwent percutaneous fixation. Both cohorts had similar preoperative data including age (p=0.54) and gender (p=0.505). In comparison to open surgery group, the patients who underwent percutaneous fixation had significantly lesser operation time (46.63 + 6.25 minutes vs 89.88 + 9.05 minutes, p<0.01), lesser intraoperative blood loss (78.75 + 23.93 ml vs 330.40 + 101.87ml, p<0.01), greater intraoperative fluoroscopic exposure time (400.19 + 31.22 seconds vs 190.06 + 30.28 seconds, p<0.01), and lesser hospital stay time (3.13 + 0.871 days vs 5.08 + 1.209days, p<0.01). The incidence of post-surgery complications like screw malpositioning (p=0.621) and infection (p=0.733) was similar in both cohorts. The fracture union rates were also comparable in both cohorts (p=0.664). Conclusion: Minimally inavsive percutaneous posterior pedicle screw fixation had lesser operation time, blood loss, and hospital stay duration and greater fluoroscopic exposure than conventional open posterior pedicle screw fixation among patients with traumatic thoracolumbar fractures in our studied population. It also had a similar radilogic outcome and post-operative adverse events like screw malpositioning and local infection, showing the non-inferiority as compared to conventional open instrumentation. Prospective trials with large sample size are required to find superiority if any of one modality over other exists in our people.