Abstract
Introduction
The concepts of “tissue-sparing surgery” and “mini-invasiveness” are gradually involving the surgical approach to spine pathologies, both traumatic and degenerative.
Patients and Methods
The aim of the study is to evaluate the fracture healing model in case of unstable thoracolumbar vertebral fractures surgical treatment, treated by posterior percutaneous transpedicular stabilization (PPTS). Since March 2011, 89 patients with this fracture pattern, without neurologic involvement (according to ASIA classification) were enrolled in the study. Patients were randomly divided into two homogeneous samples. PPTS (with rods and screws) and standard posterior open approach were performed in patients of groups A (46 patients) and B (43 patients, control), respectively. A clinical and radiographical follow-up was performed respectively at months 1, 3, 6, 12 (according to visual analog scale [VAS] and Oswestry Disability Index [ODI]) and at months 1, 6, 12 (dynamic radiographic studies in the last two times). Segmental kyphosis and wedge-shaped deformity amount of the involved vertebral bodies, were measured pre- and postsurgery. At month 12, a CT scan with 3D reconstruction and analysis of chrome-densitometry was obtained. The data were analyzed by mean of the Kaplan–Meier curve (results yielding p < 0.05 were considered statistically significant).
Results
Clinically, in group A, we have observed a progressive and more rapid VAS and ODI scores improvement. Vertebral body collapse or kyphosis progression was not observed. There were no “fixation failure” and no patient underwent revision surgery. The 3D reconstructions and the chrome-densitometry evaluation at month 12 showed a more homogeneous and organized trabecular architecture recovery in group A (vs. group B). The PPTS acts as an “angular stability” fixation system; it allows a “biological” healing process (according to Wolf law), producing better clinical and radiographical results.
Conclusion
Unstable thoracolumbar fractures PPTS is an effective alternative to the classic open standard treatment. The advantage of mini-invasive spine surgery and “biological” healing process explain these better results and faster recovery times. This technique represents a safe and effective treatment, in terms of clinical and radiographical findings.