Combined posterior percutaneous pedicle screw fixation with anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures: an institutional experience.

Abstract

<h4>Introduction</h4>This study aimed to assess the feasibility as well as the clinical and radiological outcomes of posterior percutaneous pedicle screw fixation (PPSF) combined with anterior monosegmental column reconstruction in unstable thoracolumbar burst fractures.<h4>Methods</h4>From January 2015 to August 2022, 65 consecutive patients with unstable thoracolumbar burst fractures were enrolled in this study. The patients underwent posterior PPSF combined with anterior monosegmental reconstruction, utilising titanium mesh cages. Primary outcomes included patient reported outcomes defined by the visual analog scale (VAS) score of low back and leg and ability to return to work. Secondary outcomes included radiological parameters, and treatment-related complications.<h4>Results</h4>The mean age of the patients was 48.2 ± 12.3 years. These patients were followed up for a period of 28.2 ± 14.1 months The VAS pain score significantly improved postoperatively (<i>P</i> = 0.028), and this improvement was maintained until the final follow-up. 32 (49.2%) patients returned to work within 6 months and a further 33 (50.8%) returned to work subsequently. At the time of the final follow-up, 42 of 65 (64.6%) patients had returned to a similar job, and 23 (35.4%) patients changed to a less physically demanding job. In 39 patients with neurologic dysfunction, 34 (87.2%) had improvement after surgery. Radiologically, the mean sagittal kyphosis was corrected from 16.3 ± 12.7 preoperatively to 2.2 ± 1.8 postoperatively (<i>P</i> < 0.001), which remained stable at the final follow-up. No obvious subsidence of the titanium mesh cage and no dislodgement, loosening or breakage of the instrumentation was observed in any patient during the follow-up period. Solid bony fusion was achieved in all patients.<h4>Conclusions</h4>Combined posterior PPSF with anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures is safe and can achieve good clinical and radiological outcomes.