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Minimally Invasive Surgery for the Treatment of Traumatic Monosegmental Thoracolumbar Burst Fractures

Clinical and Radiologic Outcomes of 144 Patients With a 6-year Follow-Up Comparing Two Groups With or Without Intermediate Screw

Trungu, Sokol, MD*,†; Forcato, Stefano, MD*,†; Bruzzaniti, Placido, MD*; Fraschetti, Flavia, MD*; Miscusi, Massimo, MD, PhD*; Cimatti, Marco, MD, PhD*; Raco, Antonino, MD, PhD*

doi: 10.1097/BSD.0000000000000791
PRIMARY RESEARCH
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Study Design: This was a retrospective study of the clinical and radiologic outcomes of traumatic thoracolumbar (TL) burst fractures.

Objectives: We aimed to evaluate the clinical and radiologic outcomes after 6 years of follow-up of 144 patients with monosegmental TL burst fractures treated with percutaneous short-segment pedicle screw fixation, comparing two groups with versus without placement of an intermediate screw at the fractured vertebra.

Summary of Background Data: Traumatic TL fractures are the most common vertebral fractures, especially at the TL junction (T10–L2). Minimally invasive surgery (MIS) is a valuable treatment option for traumatic TL burst fractures.

Materials and Methods: The clinical outcomes and radiologic parameters (Cobb angle, midsagittal index, and sagittal index) of 144 patients with traumatic monosegmental TL fractures treated with MIS were evaluated preoperatively, postoperatively, and after 3 and 6 years of follow-up. Patients were categorized into a nonintermediate screw group (nISG) and an intermediate screw group (ISG), and the groups were compared.

Results: There were 71 patients (49.3%) in the nISG and 73 patients (50.7%) in the ISG. The radiologic parameters improved significantly more from the preoperative evaluation to the 6-year follow-up in the ISG than in the nISG (P<0.025). There were no significant differences in the mean Oswestry Disability Index (ODI) and Visual Analog Scale scores at the 6-year follow-up between the ISG and the nISG: 15.6% (ISG) versus 16.8% (nISG) for ODI (P<0.1) and 2.2 (ISG) versus 2.4 (nISG) for Visual Analog Scale score (P<0.85) (P<0.73).

Conclusions: MIS showed good clinical outcomes 6 years after surgery in both the ISG and the nISG. The additional intermediate screw significantly improved radiologic parameters but not clinical outcomes.

*N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome

Neurosurgery Unit, Card. G. Panico Hospital, Tricase, Italy

The authors declare no conflict of interest.

Reprints: Sokol Trungu, MD, Via Campaldino 16 Rome, Italy (e-mail: s_trungu@hotmail.com).

Received December 24, 2017

Accepted January 8, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.