Object The main aim of this study was to compare clinical and radiological outcomes after stabilization by a percutaneous transpedicular system and stabilization from the standard open approach for thoracolumbar spine injury. Methods Thirty-seven consecutive patients were enrolled in the study over a period of 16 months. Patients were included in the study if they experienced 1 thoracolumbar fracture (A3.1–A3.3, according to the AO/Magerl classification), had an absence of neurological deficits, had no other significant injuries, and were willing to participate. Eighteen patients were treated by short-segment, minimally invasive, percutaneous pedicle screw instrumentation. The control group was composed of 19 patients who were stabilized using a short-segment transpedicular construct, which was performed through a standard midline incision. The pain profile was assessed by a visual analog scale (VAS), and overall satisfaction by a simple 4-stage scale relating to performance of daily activities. Working ability and return to original occupation were also monitored. Radiographic follow-up was defined by the vertebral body index (VBI), vertebral body angle (VBA), and bisegmental Cobb angle. The accuracy of screw placement was examined using CT. Results The mean surgical duration in the percutaneous screw group was 53 ± 10 minutes, compared with 60 ± 9 minutes in the control group (p = 0.032). The percutaneous screw group had a significantly lower perioperative blood loss of 56 ± 17 ml, compared with 331 ± 149 ml in the control group (p < 0.001). Scores on the VAS in patients in the percutaneous screw group during the first 7 postoperative days were significantly lower than those in the control group (p < 0.001). There was no significant difference between groups in VBI, VBA, and Cobb angle values during follow-up. There was no significant difference in screw placement accuracy between the groups and no patients required surgical revision. There was no significant difference between groups in overall satisfaction at the 2-year follow-up (p = 0.402). Working ability was insignificantly better in the percutaneous screw group; previous working position was achieved in 17 patients in this group and in 12 cases in the control group (p = 0.088). Conclusions This study confirms that the percutaneous transpedicular screw technique represents a viable option in the treatment of preselected thoracolumbar fractures. A significant reduction in blood loss, postoperative pain, and surgical time were the main advantages associated with this minimally invasive technique. Clinical, functional, and radiological results were at least the same as those achieved using the open technique after a 2-year follow-up. The short-term benefits of the percutaneous transpedicular screw technique are apparent, and long-term results have to be studied in other well-designed studies evaluating the theoretical benefit of the percutaneous technique and assessing whether the results of the latter are as durable as the ones achieved by open surgery.

There are numerous indications for stabilization using instrumentation of the upper cervical spine. This area is comprised of sophisticated anatomy. There is no study describing bony and vascular anomalies of this area in the middle European population. The main aim of this study was to investigate prevalence of any vertebral artery (VA) variations and osseous anomalies in the region of the craniocervical junction in a large sample of Czech patients based on three-dimensional computed tomographic angiography (3D CTA). The VA has a variable course through C2 before it passes above its groove on the posterior arch of C1. The artery can course more medially, more posteriorly or more superiorly, thus limiting the diameter of the bony elements used as landmarks for the safe insertion of metalwork. This is known as a high-riding VA (HRVA). The VA was considered HRVA in this study if the thickness of the C2 isthmus was less than 5 mm and/or the C2 internal height was less than 2 mm and/or the width of the C2 pedicle was less than 4 mm. The prevalence of ponticulus posticus (PP) was also identified. Following the VA variations in the V3 segment of the artery were persistent first intersegmental artery (FIA), fenestration (FEN) of the VA, and the posterior inferior cerebellar artery (PICA) branch originating from the C1/2 part of VA. Records of 511 patients from our institution were analyzed. The mean age of the patients was 63.6 years. One hundred and twenty-three (24.1 %) patients were identified to have HRVA, 30 (6 %) present on both sides. The age of patient over 70 years and female sex were found to be significant risk factors for HRVA presence. The prevalence of a nearby PICA branch was 4 %, FIA was 0.4 %, and FEN was 0.2 %. The presence of PP was identified in 14.3 % of patients. The HRVA and PP are common anomalies in the Czech population, and routine preoperative high-resolution CT evaluation is mandatory to prevent the VA injury when C1-C2 instrumentation is planned. The female sex and age over 70 years were found to be the most important factors for HRVA presence. The FIA and the FEN VA were rare in our study contrary to reports published from Asia, showing as many as a 10 % the VA presence over the starting point for C1 lateral screw. On the basis of the infrequent occurrence of these anomalies, we do not recommend routine CT angiography when upper cervical spine instrumentation in the normal population is planned.