Treatment of thoracolumbar fractures: comparison of the clinical and radiological outcomes of percutaneous versus open surgery

Abstract

Study design: Retrospective study.

Introduction: Spinal fractures are common trauma that can be treated by a range of techniques, from functional to surgical. Spine surgery has been around for many years. The first procedures were done open but have been plagued by numerous complications-sometimes severe-and substantial intraoperative blood loss. Percutaneous surgery was developed to help reduce the complications while providing similar clinical and radiological outcomes to open surgery. We conducted a study to compare open and percutaneous surgery and to evaluate other complications as well as short- and medium-term clinical and radiological results.

Material and methods: Retrospective, single-center study comparing two cohorts of patients suffering from an isolated vertebral fracture who were operated using either an open or percutaneous technique. Included were patients who had an isolated vertebral fracture between T10 and L3 and were operated between 01/01/2016 and 31/12/2018 at the Reims university hospital. These patients were reviewed in person after a minimum of 18 months postoperative for clinical and radiological assessments. The Mercuriali and Brecher formula was used to calculate intraoperative blood loss based on pre- and postoperative hematocrit; the total blood volume was determined with the Nadler formula.

Results: The study cohort consisted of 79 patients operated by percutaneous surgery and 55 patients operated by open surgery. The blood loss in the percutaneous surgery group was 176 mL versus 220 mL in the open surgery group (p = 0.02). The length of hospital stay was shorter after percutaneous surgery (mean of 3.6 days) than after open surgery (mean of 5.5 days) (p < 0.001). Also, the pedicle screw placement was optimal in 88% of percutaneous procedures versus 67% of open procedures (p < 0.001).

Conclusion: Percutaneous surgery for thoracolumbar fractures causes less blood loss than conventional open surgery. The clinical and radiological results are on par with conventional open surgery. The mean length of hospital stay is shorter and the accuracy of pedicular screw placement is higher with percutaneous surgery. Thus, we can conclude that percutaneous surgery is the preferred treatment for thoracolumbar fractures when no neurological deficit is present.

Level of evidence: IV.

Keywords: Intraoperative blood loss; Percutaneous surgery; Thoracolumbar fracture.