Addition of intermediate screws to percutaneous pedicle screws for thoracolumbar fractures

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
32 patients with a thoracolumbar fracture were randomized to receive either percutaneous short-segmental pedicle screw fixation with intermediate screws or percutaneous bilateral pedicle screw fixation without intermediate screws. The purpose of this study was to compare the two techniques in terms of operative time, estimated blood loss, postoperative back pain and function, sagittal Cobb angle, vertebrae body index, anterior vertebrae body height, and complications. Outcomes were assessed Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
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Why was this study needed now?
A common surgical treatment for thoracolumbar fractures is posterior bilateral pedicle screw fixation. However, potential severe postoperative complications associated with the traditional open approach, including pain, atrophy, and muscular denervation, have had medical professionals exploring alternative techniques. Minimally invasive percutaneous bilateral pedicle screw fixation has been suggested in hopes of combating such complications, and has been reported to yield favourable perioperative outcomes. Additionally, the use of intermediate screws (screws placed within the fractured vertebra) has been hypothesized to improve stability of fixation, and may have an impact on postoperative outcomes. However, there is limited evidence comparing percutaneous bilateral pedicle screw fixation with and without the addition of intermediate screws.
What was the principal research question?
In treatment of thoracolumbar fractures, is percutaneous pedicle screw fixation with intermediate screws safe and efficacious compared to percutaneous bilateral pedicle screw fixation without intermediate screw placement, assessed up to 1 year postoperatively?
Population: 32 patients with type A thoracolumbar fracture, and scheduled for pedicle screw fixation under general anaesthesia
Intervention: Intermediate screw group: Patients underwent percutaneous bilateral pedicle screw fixation at immediate adjacent levels, with the addition of placement of intermediate screws in the fractured vertebral level (n=16, Mean age: 38.0+/-8.2; 13M/3F)
Comparison: Control group: Patients underwent standard percutaneous bilateral pedicle screw fixation, without intermediate screw placement (n=16; Mean age: 36.6+/-8.6; 13M/3F)
Outcomes: Clinical outcomes included the Oswestry Disability Index (ODI) to assess function and a visual analogue scale (VAS) to assess back pain. Radiographic outcomes included the anterior vertebral body height (AVBH; the relation between anterior and posterior walls of the affected vertebral body [%]), sagittal Cobb's angle, and the vertebral body index (VBI; the relation between the body height of the affected vertebral body and the adjacent vertebrae [%]). Operation time (minutes) and intraoperative blood loss (milliliters) were also documented.
Methods: RCT; single-center
Time: Outcomes were assessed at 1 week, 6 months, and 1 year postoperatively. Correction loss of radiographic outcomes were only reported at 6 months and 1 year postoperatively.
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The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.