Effect of Manual Reduction Combined with Internal Fixation Through Wiltse Paraspinal Approach in the Treatment of Thoracolumbar Fracture (AO type A3)

Abstract

Background: Thoracolumbar fractures (TF) are the most frequent fractures of the spine, and the current treatment for TF (AO Type A3) is the Wiltse approach with pedicle screw fixation or percutaneous pedicle screw fixation. However, secondary collapse often occurs after operation. To reduce the incidence of such events, preoperative manual reduction (MR) is an efficient method. The purpose of this study is to investigate the impact of successful PMR on prognosis of patients with TF. Methods: From 2018 to 2022, 97 patients are enrolled to the study. Patients are divided into three groups, MR failure (MRF), succeeded (MRS) and instrument reduction (IR). The different time of the Cobb angel (CA) and vertebral body height ratio (VBHR) are obtained for three groups. The visual analog scale (VAS) is used to help patients assess the intensity of their pain, and oswestry disability index (ODI) is regarded as the gold standard for evaluating the degree of dysfunction caused by TF. Results: The recovery of CA and VBHR, MRS and IR is significantly better than MRF at 2 days and 6 months after operation. The CA and VBHR are found to be different between preoperative and 2 days, 6 months after operation. The CA and VBHR in MRF are decreased at 6 months after surgery compared with 2 days after surgery. In the results of VBHR 6 months after operation, there is significant difference between MRS and IR. Conclusion: Successful preoperative manual reduction can greatly improve and maintain vertebral height and spinal physiological curvature. In addition, according to the success of manual reduction, TF of AO Type A3 can be divided into A3a and A3b.