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


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: 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 > 4m­m) 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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