Purpose Traumatic thoracolumbar (TL) fractures are the most common vertebral fractures. Although a consensus on the preferred treatment is missing, percutaneous pedicle screw fixation (PPSF) has been progressively accepted as treatment option, since it is related to lower soft tissues surgical-injury and perioperative complications rate. This study aims to evaluate the long-term clinical-radiological outcomes after PPSF for TL fractures at a single tertiary academic hospital. Methods This is a retrospective cohort study. Back pain was obtained at preoperative, postoperative and final follow-up using Visual Analog Scale. Patient-reported outcomes, the Oswestry Disability Index and the 36-Item Short Form, were obtained to asses disability during follow-up. Radiological measures included Cobb angle, mid-sagittal index, sagittal index (SI) and vertebral body height loss. A multivariate regression analysis on preoperative radiological features was performed to investigate independent risk factors for implant failure. Results A total of 296 patients with 368 TL fractures met inclusion criteria. Mean follow-up was 124.3 months. The clinical and radiological parameters significantly improved from preoperative to last follow-up measurements. The multivariate analysis showed that Cobb angle (OR = 1.3, p < 0.001), SI (OR = 1.5, p < 0.001) and number of fractures (OR = 1.1, p = 0.05), were independent risk factors for implant failure. The overall complication rate was 5.1%, while the reoperation rate for implant failure was 3.4%. Conclusions In our case series, PPSF for TL injuries demonstrated good long-term clinical-radiological outcomes, along with low complication and reoperation rates. Accordingly, PPSF could be considered as a valuable treatment option for neurologically intact patients with TL fractures. Additionally, in this cohort, number of fractures >= 2, Cobb angle >= 15 degrees and sagittal index >= 21 degrees were independent risk factors for implant failure.

Percutaneous pedicle screw fixation without arthrodesis of 368 thoracolumbar fractures: long-term clinical and radiological outcomes in a single institution / Trungu, Sokol; Ricciardi, Luca; Forcato, Stefano; Piazza, Amadeo; D'Andrea, Giancarlo; Polli, Filippo Maria; Cimatti, Marco; Frati, Alessandro; Miscusi, Massimo; Raco, Antonino. - In: EUROPEAN SPINE JOURNAL. - ISSN 1432-0932. - (2022). [10.1007/s00586-022-07339-z]

Percutaneous pedicle screw fixation without arthrodesis of 368 thoracolumbar fractures: long-term clinical and radiological outcomes in a single institution

Trungu, Sokol
Primo
;
Ricciardi, Luca;Forcato, Stefano;Piazza, Amadeo;D'Andrea, Giancarlo;Polli, Filippo Maria;Cimatti, Marco;Frati, Alessandro;Miscusi, Massimo;Raco, Antonino
2022

Abstract

Purpose Traumatic thoracolumbar (TL) fractures are the most common vertebral fractures. Although a consensus on the preferred treatment is missing, percutaneous pedicle screw fixation (PPSF) has been progressively accepted as treatment option, since it is related to lower soft tissues surgical-injury and perioperative complications rate. This study aims to evaluate the long-term clinical-radiological outcomes after PPSF for TL fractures at a single tertiary academic hospital. Methods This is a retrospective cohort study. Back pain was obtained at preoperative, postoperative and final follow-up using Visual Analog Scale. Patient-reported outcomes, the Oswestry Disability Index and the 36-Item Short Form, were obtained to asses disability during follow-up. Radiological measures included Cobb angle, mid-sagittal index, sagittal index (SI) and vertebral body height loss. A multivariate regression analysis on preoperative radiological features was performed to investigate independent risk factors for implant failure. Results A total of 296 patients with 368 TL fractures met inclusion criteria. Mean follow-up was 124.3 months. The clinical and radiological parameters significantly improved from preoperative to last follow-up measurements. The multivariate analysis showed that Cobb angle (OR = 1.3, p < 0.001), SI (OR = 1.5, p < 0.001) and number of fractures (OR = 1.1, p = 0.05), were independent risk factors for implant failure. The overall complication rate was 5.1%, while the reoperation rate for implant failure was 3.4%. Conclusions In our case series, PPSF for TL injuries demonstrated good long-term clinical-radiological outcomes, along with low complication and reoperation rates. Accordingly, PPSF could be considered as a valuable treatment option for neurologically intact patients with TL fractures. Additionally, in this cohort, number of fractures >= 2, Cobb angle >= 15 degrees and sagittal index >= 21 degrees were independent risk factors for implant failure.
2022
Burst fracture; Minimally invasive surgery; Percutaneous pedicle screw fixation; Posterior short-segment fixation; Thoracolumbar fracture
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Percutaneous pedicle screw fixation without arthrodesis of 368 thoracolumbar fractures: long-term clinical and radiological outcomes in a single institution / Trungu, Sokol; Ricciardi, Luca; Forcato, Stefano; Piazza, Amadeo; D'Andrea, Giancarlo; Polli, Filippo Maria; Cimatti, Marco; Frati, Alessandro; Miscusi, Massimo; Raco, Antonino. - In: EUROPEAN SPINE JOURNAL. - ISSN 1432-0932. - (2022). [10.1007/s00586-022-07339-z]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1665238
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