Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures

Abstract

Background:To assess the safety and efficacy of percutaneous short-segment pedicle instrumentation compared with conventionally open short-segment pedicle instrumentation and provide recommendations for using these procedures to treat thoracolumbar fractures.Methods:The Medline database, Cochrane database of Systematic Reviews, Cochrane Clinical Trial Register, and Embase were searched for articles published. The randomized controlled trials (RCTs) and non-RCTs that compared percutaneous short-segment pedicle instrumentation to open short-segment pedicle instrumentation and provided data on safety and clinical effects were included. Demographic characteristics, clinical outcomes, radiological outcomes, and adverse events were manually extracted from all of the selected studies. Methodological quality of included studies using Methodological Index for Non-Randomized Studies scale and Cochrane collaboration's tool for assessing the risk of bias by 2 reviewers independently.Results:Nine studies encompassing 433 patients met the inclusion criteria. Subgroup meta-analyses were performed according to the study design. The pooled results showed there were significant differences between the 2 techniques in short- and long-term visual analog scale, intraoperative blood loss, operative time, postoperative draining loss, hospital stay, and incision size, although there were no significant differences in postoperative radiological outcomes, Oswestry Disability Index, hospitalization cost, intraoperative fluoroscopy time, and adverse events.Conclusion:Percutaneous short-segment pedicle instrumentation in cases with achieve satisfactory results, could replace in many cases extensive open surgery and not increased related complications. However, further high-quality RCTs are needed to assess the long-term outcome of patients between 2 techniques.

Instrumentation Removal following Minimally Invasive Posterior Percutaneous Pedicle Screw-Rod Stabilization (PercStab) of Thoracolumbar Fractures Is Not Always Required

“…All patients showed positive outcomes following surgery, reporting minimal disability, mild pain, and high satisfaction with their surgery. PercStab is a reliable and accurate treatment for thoracic and lumbar spine fractures [ 26 ]. This case series demonstrated PercStab offers minimal surgical morbidity and blood loss similar to previous studies [ 27 ].…”

The Feasibility of Long-Segment Fluoroscopy-guided Percutaneous Thoracic Spine Pedicle Screw Fixation, and the Outcome at Two-year Follow-up

“…Furthermore, minimally invasive spinal surgeries for instrumentation, when performed in an emergency setting, might show great potentiality for reducing the surgical invasiveness, thus allowing a faster mobilisation, which might improve the overall outcome in poly-trauma patients 8, 9 . A recent meta-analysis, conducted by Feng Tian et al 10 , showed that the percutaneous procedures for treating thoracic and lumbar spine fractures have better results in terms of post-operative pain, blood loss, time of operation, hospital stay; however, there were no advantages in terms of radiological outcomes and perioperative complication rates. On the other hand, some disadvantages were also reported: longer operating time, increased use of fluoroscopy, inadequate deformity correction, and lower chances for arthrodesis.…”

Evaluation of image quality and assessability of a new flat‐panel 3D C‐arm compared to mobile and fixed computed tomography in posterior spinal fixation

“…To minimise surgical impact on the patients, cannulated screw systems for percutaneous placement of the screws were developed. This technique has proved very useful, especially in traumatic fixations were a definitive fusion is usually not needed 3 . Here, the entry point is visualized fluoroscopically.…”