Percutaneous Indirect Decompression And Internal Fixation For Treatment Of Thoracolumbar Burst Fracture With Neurological Deficits

Objective:To investigate the clinical efficacy and safety of treating thoracolumbar burst fractures with neurological deficits by using posterior percutaneous pedicle screw rod distraction reduction,indirect decompression and internal fixation.Methods :There were 25 patients with thoracolumbar burst fracture with neurological deficits who were admitted to the department of spine surgery of the First Affiliated Hospital of Guangzhou Medical University from June 2015 to June 2017,including 17 males and 8females with age from 20 to 60 years(average,33.7 years),and treated with posterior percutaneous pedicle screw rod distraction and indirect decompression and internal fixation.The clinical efficacy was evaluated by VAS scores of low back pain and Frankel grade of nerve function;The vertebral reduction and spinal canal decompression were estimated by comparing the vertebral height,wedge angle(VWA),location rate of spinal canal,and Cobb angle of injured segment between preoperative,postoperative,and follow-up.the canal remolding in the injured vertebra was appraised by regular CT scan in follow-up;The safety of the procedure was also assessed by observating operative injury,wounds and internal plant-related complications.Results:All patients' operations were successfully completed.The VAS score of low back pain improved from(8.30±0.66)preoperatively to(2.05±0.69)3 days after operation.The Frankel's grade of neurological function was improved by 1.3±0.5 grades in average at the last follow-up compared to preoperatively.The spinal canal occupancy rate was improved from(42.25±9.95)% preoperatively to(15.30±5.53)% 3 days after surgery,to(5.05±3.52)% at the last follow-up.The anterior height of injuryed vertebra was restored from(50.15±8.50)% preoperatively to(92.65±5.35)% 3 days after surgery,(87.90±4.37)% at the last follow-up.No nerve roots and dural sac were injuryed in the operation.One case with wound redness and swelling was cured by oral antibiotics and dressing.No internal fixation related complications were fund at followed up.Conclusion:The techniqes of posterior percutaneous pedicle screw rod distraction reduction and internal fixation can achieve effective reduction of the injured vertebral hight and indirect decompression of the spinal canal,avoid intraspinal interference and damage to posterior spinal structure,with fewer complications,shortly hospital stay and satisfactory clinical efficacy.It is a minimally invasive,safe and effective treatment option for thoracolumbar burst fracture with incomplete nerve injury.