Clinical Effect Of Percutaneous Pedicle Screw Fixation Combined With Intervertebral Foraminoscopy Surgery In The Treatment Of Thoracolumbar Burst Fractures With Neurological Impairment

Objective:To evaluate the clinical effect of minimally invasive percutaneous pedicle screw fixation combined with percutaneous transforaminal endoscopic decompression in the treatment of thoracolumbar vertebral burst fracture with neurological impairment.Methods:Retrospectively analysed the patients with thoracolumbar burst fracture treated by minimally invasive percutaneous pedicle screw fixation from August 2015 to September 2019,7 patients had no significant improvement in neurological symptoms and all had poor reduction of posterior process bone mass.These patients were treated with the second stage of percutaneous transforaminal endoscopic decompression surgery for spinal canal molding and nerve decompression(percutaneous group),and the other 25 patients underwent traditional open surgery(open group).The anterior height percentage,sagittal kyphosis cobb angle,spinal cord injury ASIA sensory score,Visual analogue scale(VAS),Oswestry disability index(ODI)and complications were recorded before and after operation to evaluate the clinical efficacy of the two treatments of thoracolumbar burst fractures with neurological impairment.Results:All patients successfully completed the operation,All patients were followed up,The main follow-up was network or telephone follow-up.The VAS score of percutaneous group was 9.2±0.8 before operation,and 0.6±0.5 in one year after operation,of open group 9.1±0.8 before operation,and 2.0±1.0 in one year after operation.The difference before and after operation was statistically significant(P<0.05)and significant difference was found between 2 groups in one year after operation(P<0.05);The preoperative ODI index of percutaneous group was(90.3±8.0)%,and the postoperative index of one year was(4.8±1.8)%,of open group(87.3±6.7)%before operation and(19.3±4.6)%in one year after operation.The difference before and after operation was statistically significant(P<0.05)and significant difference was found between 2 groups in one year after operation(P<0.05);Before surgery,the anterior height ratio was(58.8±13.7)%,after surgery(92.6±4.5)%,of open group(69.2±8.1)%before operation,and(91.4±6.6)%after operation,the difference before and after operation was statistically significant(P<0.05).Sagittal kyphosis Cobb was(13.2±7.6)°before operation,after surgery(-4.5±5.4)°,of open group(12.7±6.8)°before operation,and(2.9±6.6)°after operation,the difference before and after operation was statistically significant(P<0.05),The sensory scores ASIA spinal cord injury were all restored to grade E.No postoperative complications occurred in all patients.Conclusion:Scholars generally believed that minimally invasive percutaneous pedicle screw fixation for thoracolumbar burst fracture indications:no neurological impairment symptoms,no decompression of the spinal canal and posterior process bone mass less than 1/3 diameter of the spinal canal.In this study,combined with percutaneous transforaminal endoscopic canal molding and nerve decompression techniques,the problems of poor bone mass reduction and residual neurological impairment in patients with thoracolumbar burst fracture after percutaneous pedicle screw fixation were solved.This study has expanded the minimally invasive surgical indication of thoracolumbar burst fracture and avoided the traditional open surgery of thoracolumbar burst fracture with nerve function damage.It can also restore the height of injured vertebral body,fully decompress the spinal canal,restore the nerve function of patients,and have the advantages of minimally invasive and less surgical trauma.