A comparison of mini-invasive percutaneous versus classic open pedicle screw fixation of thoracolumbar fractures – retrospective analysis

Czech version

Authors: P. Krupa; M. Bartoš; T. Česák; V. Málek; T. Hosszú
Authors‘ workplace: Neurochirurgická klinika LF UK a FN Hradec Králové
Published in: Cesk Slov Neurol N 2018; 81(6): 678-685
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2018678

Overview

Aims:

Evaluation of pedicular screw insertion precision, Cobb’s angle, vertebral body angulation (VBA), vertebral body index (VBI), duration of surgery and X-ray exposure time in classic open and mini-invasive percutaneous stabilisation of traumatic vertebral fractures of the middle and lower thoracic and lumbar spine.

Patients and methods:

Retrospective analysis of patients who suffered from traumatic vertebral fractures of the middle and lower thoracic and lumbar spine. Patients were operated on by classic open posterior stabilisation (OPEN group) or by mini-invasive percutaneous posterior stabilisation (MIS group) with insertion of pedicular screws. In this study, patients with traumatic T8– L5 vertebral fracture(s) who had postoperative CT scans during January 1 2015–January 1 2018 were included. Pedicular screw position was evaluated on axial planes of the postoperative CT scan and classified using the modified Gertzbein’s grading scale. Furthermore, parameters of the kyphosis (Cobb’s angle, VBA and VBI) of the involved region were calculated and compared pre- and postoperatively. Finally, using patients’ charts the duration of surgery and X-ray exposure time and Kerma-Area Product were compared.

Results:

During 2015– 2018, a total of 147 patients were included in the study. The MIS group had 47 patients, and the OPEN group had 100 patients. Correct pedicular screw position was achieved in 93.1% in the MIS group and in 94.4% in the OPEN group. We found no significant difference in Cobb’s angle, VBI and VBA between the groups. Duration of surgery was significantly shorter in the MIS group – 91 vs. 103 min. X-ray exposure time was significantly longer in the MIS group – 45 vs. 33 s. We had a 2% infection rate in the OPEN group, but we did not record any such complications in the MIS group.

Conclusions:

The total number of pedicular screw malpositions in our study did not differ significantly between the groups. We registered a higher number of grade 3A pedicular screw malpositions (medial pedicle breach > 4 mm) according to the modified Gertzbein’s grading scale leading to a higher number of reoperations in the MIS group. However, this was likely due to learning curve issues. In the OPEN group, the duration of surgery was significantly longer in the OPEN group; on the other hand, X-ray exposure time was significantly shorter. There were no infectious complications in the MIS group.

Key words:

open stabilisation – mini-invasive percutaneous stabilisation – traumatic vertebral fractures – pedicular screw – X-ray exposure time

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Chinese summary - 摘要

王莹莹 - 微创经皮与经典开胸椎弓根螺钉内固定治疗胸腰椎骨折的比较 - 回顾性分析

目的：

评估椎弓根螺钉插入精度，Cobb角，椎体角度（VBA），椎体指数（VBI），手术持续时间和X射线暴露时间的经典开放和微创经皮稳定创伤性椎体骨折的中间和下胸椎和腰椎。

患者和方法：

回顾性分析中下胸椎和腰椎创伤性椎体骨折患者的临床资料。患者通过经典开放后路稳定（OPEN组）或通过微创经皮后路稳定（MIS组）和椎弓根螺钉插入进行手术。在本研究中，包括在2015年1月1日至2018年1月1日期间进行了术后CT扫描的创伤性T8-L5椎体骨折患者。在术后CT扫描的轴平面上评估椎弓根螺钉位置，并使用改良的Gertzbein分级量表进行分类。此外，计算并在术前和术后比较所涉及区域的脊柱后凸参数（Cobb角，VBA和VBI）。最后，使用患者的图表，比较手术持续时间和X射线暴露时间和Kerma-区域产品。

结果：

在2015年至2018年期间，共有147名患者参与了该研究。 MIS组有47名患者，OPEN组有100名患者。 MIS组的椎弓根螺钉位置正确率为93.1％，OPEN组为94.4％。我们发现各组之间的Cobb角，VBI和VBA没有显著差异。 MIS组的手术时间明显缩短 - 91对103分钟。 MIS组的X射线暴露时间明显更长--45对33秒。我们在OPEN组中感染率为2％，但我们没有在MIS组中记录任何此类并发症。

结论：

在我们的研究中，椎弓根螺钉错位的总数在各组之间没有显著差异。我们根据改良的Gertzbein分级量表登记了更高数量的3A级椎弓根螺钉错位（内侧椎弓根缺损> 4 mm），导致MIS组的再次手术次数增加。然而，这可能是由于学习曲线问题。在OPEN组，OPEN组的手术时间明显延长; 另一方面，X射线曝光时间明显缩短。 MIS组没有感染性并发症。

关键词：

开放式稳定 - 微创经皮稳定 - 创伤性椎骨骨折 - 椎弓根螺钉 - X射线暴露时间

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