Clinical efficacy of decompression under full-endoscope and percutaneous pedicle screw fixation in the treatment of single-level thoracolumbar burst fracture
Clinical efficacy of decompression under full-endoscope and percutaneous pedicle screw fixation in the treatment of single-level thoracolumbar burst fracture
Objectives:To explore the safety and early effectiveness of decompression under full-endoscope and percutaneous pedicle screw fixation in the treatment of single-level thoracolumbar burst fractures.Methods:The clinical data of 9 patients with single-segment thoracolumbar burst fracture treated with spinal canal decompression under full-endoscope and percutaneous pedicle screw fixation from April 2021 to June 2022 in our hospital were analyzed retrospectively,including 7 males and 2 females.The age ranged from 23 to 61(39.3±9.1)years old.According to AO classification,there were 6 cases of type A,2 cases of type B and 1 case of type C.Fracture segments were T12 in 2 cases,L1 in 3 cases,L2 in 3 cases,and L3 in 1 case.According to the classification of American Spinal Injury Association(ASIA)grading,there were 2 cases of type C,2 cases of type D,and 5 cases of type E.The decompression and percutaneous pedicle screw fixation were operated through the same incision in the injured vertebrae for screw placing.The operation-related indexes and complications were recorded.The patients'low back pain was evaluated by visual analogue scale(VAS)score before operation,on 3rd day after operation and at the last follow-up.The sagittal Cobb angle,height ratio of vertebral anterior edge,and the rate of spinal canal occupation were measured on spinal X-ray and CT images,and the recovery of neurological function was evaluated at the last follow-up.Results:All 9 patients successfully completed the operation,and the operative time was 105-145min(1 12.4± 21.2min),bleeding volume was 50-110mL(83.9±19.6mL),and hospitalization time was 7-13d(9.1±1.3d).No serious complications such as wound infection,cerebrospinal fluid leakage,aggravated nerve injury occurred.The follow-up time was 6-13months(8.4±3.9 months),all the fractures healed successfully,and the healing time was 3-6 months(4.7±1.6 months).The VAS score of low back pain on the 3rd day after operation and at final follow-up significantly improved compared with that before operation(P＜0.05),and it was also significantly improved at the last follow-up compared with that on the 3rd day after operation(P＜0.05).The Cobb angle,anterior height ratio of injured vertebrae,and invasion rate of spinal canal were significantly improved compared with those before operation(P＜0.05),respectively,but there was no statistical difference between the last follow-up and postoperative 3d(P＞0.05).One patient recovered from grade C to grade D of ASIA classification,while another three patients with neurological injury recovered completely.Conclusions:Decompression under full-endoscope and percutaneous pedicle screw fixation through the same incision in the injured vertebrae for screw placement in the treatment of single-level thoracolumbar burst fractures can obtain effective nerve root and spinal canal decompression,with good correction and small operative trauma,which is a safe and effective option.
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