Short segment percutaneous pedicle screw fixation after direct spinal canal decompression in thoracolumbar burst fractures: An alternative option

Objective: To investigate the surgical results of percutaneous pedicle screw fixation (PPSF) after spinal canal decompression via a small laminectomy for the treatment of thoracolumbar burst fractures.

Method: Twenty-seven patients underwent PPSF after spinal canal decompression via small laminectomies between April 2009 and April 2015. Inclusion criteria consisted of a single-level, closed, thoracolumbar burst fracture and neurological symptoms. Decompression was performed via a small laminectomy, followed by PPSF, including at the level of the fractured vertebra. Cobb angle, vertebral wedge angle, and vertebral body index were each measured from lateral radiographs before and after surgery, and at last follow-up. Neurological assessment was made using the Frankel grading system.

Results: The average follow-up period was 26 months. The preoperative average Cobb angle was 15.8° ± 6.6°, and significantly decreased to 6.5° ± 6.2° postoperatively (p < 0.001). Average Cobb angle at last follow-up increased slightly to 8.9° ± 6.9°, but this was not significant (p = 0.112). The preoperative average vertebral wedge angle was 20.6° ± 6.3°, and decreased significantly to 12.2° ± 6.2° postoperatively (p < 0.001). The vertebral body index significantly decreased from 0.58 ± 0.11 to a postoperative value of 0.78 ± 0.10 (p < 0.001). Clinically, no patient deteriorated subsequent to surgery.

Conclusion: Percutaneous pedicle screw fixation after spinal canal decompression via small laminectomy provides significant kyphotic correction and improved neurological outcome while offering decreased surgical morbidity. This may be applied as an effective primary surgery in select patients with TLBFs with neurologic symptoms.