Minimally invasive fixation techniques for thoracolumbar fractures: comparison between percutaneous pedicle screw with intermediate screw (PPSIS) and percutaneous pedicle screw with kyphoplasty (PPSK)

Jan 23, 2018European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

Less invasive methods to fix spine fractures: comparing two screw techniques with either extra support screw or bone filling

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Abstract

After surgery, both techniques corrected the segmental kyphosis angle significantly (p = 0.002).

The vertebral kyphosis angle showed a just significant correction (p = 0.06) after surgery.
Thoracic fractures were corrected less effectively than lumbar fractures (p = 0.004).
At 1-year follow-up, the vertebral kyphosis angle remained stable in both groups.
The percutaneous pedicle screw with kyphoplasty group experienced a significant loss of segmental kyphosis angle stability at 1 year (p = 0.004).
Thoracic vertebrae maintained greater angles of both vertebral kyphosis (p = 0.06) and segmental kyphosis (p < 0.001) compared to lumbar vertebrae.

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PURPOSE: To assess and compare the efficacy of two minimally invasive techniques (percutaneous pedicle screw with intermediate screw vs. percutaneous pedicle screw with kyphoplasty) for spinal fracture fixation by comparing the segmental kyphosis and vertebral kyphosis angles after trauma before surgery, after surgery, and at 4-month and 12-month follow-up.

METHODS: Data from 49 patients without neurological deficit treated by either percutaneous pedicle screw with intermediate screw or percutaneous pedicle screw with kyphoplasty were retrospectively analysed. The segmental kyphosis and vertebral kyphosis angles over time were calculated and correlated with the type of procedure, AO classification, lumbar or thoracic site and the age and sex of the patients.

RESULTS: After surgery, both techniques were found to be efficacious means of bringing about a significant correction of the segmental kyphosis angle (p = 0.002) and a just significant correction of the vertebral kyphosis angle (p = 0.06), although less effectively in thoracic fractures (p = 0.004). At follow-up, the vertebral kyphosis angle was stable in both groups, while there was a significant loss of segmental kyphosis angle stability in the percutaneous pedicle screw with kyphoplasty group at 1 year (p = 0.004); fractured thoracic vertebrae maintained a greater vertebral kyphosis angle (p = 0.06) and segmental kyphosis angle (p < 0.001), than the lumbar.

CONCLUSION: At 1 year after surgery, the use of intermediate screws in fractured vertebrae seemed to maintain a more efficacious correction with respect to kyphoplasty, although thoracic fracture sites appear to be associated with greater post-traumatic segmental kyphosis and lesser stability in the long term after both percutaneous surgical techniques.

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Minimally invasive fixation techniques for thoracolumbar fractures: comparison between percutaneous pedicle screw with intermediate screw (PPSIS) and percutaneous pedicle screw with kyphoplasty (PPSK)

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