title: Comparison of a paraspinal approach with a percutaneous approach in the treatment of thoracolumbar burst fractures with posterior ligamentous complex injury: a prospective randomized controlled trial.
abstract: OBJECTIVE
  This prospective randomized controlled study compared the efficacy and safety of two paraspinal muscle-sparing surgical approaches for the management of neurologically intact patients with thoracolumbar burst fractures and posterior ligamentous complex injuries.
  
  
  METHODS
  Patients were randomized to undergo either percutaneous (n=31) or paraspinal (n=30) fluoroscopically-guided pedicle screw-rod fixation, and were followed for ≥3 years. Preoperative postural reduction was attempted in all patients.
  
  
  RESULTS
  The percutaneous approach was associated with significantly less intraoperative blood loss and shorter duration of surgery and hospitalization, as well as less pain and better functional recovery at 3 months after surgery compared with the paraspinal approach. Paraspinal surgery resulted in significantly better correction of kyphosis and restoration of vertebral height compared with percutaneous surgery. There were no differences in long-term clinical outcomes between the two groups.
  
  
  CONCLUSIONS
  The minimally invasive percutaneous approach appears to be better in cases of successful postural reduction. The paraspinal approach results in better surgical correction and is, therefore, recommended for patients without successful postural reduction.
authors.affiliation: Department of Spinal Surgery, Fourth Clinical College of Peking University, Beijing Jishuitan Hospital, Beijing, China.
authors.forename: X Z
authors.initials: XZ
authors.lastname: Jiang
authors.forename: W
authors.initials: W
authors.lastname: Tian
authors.forename: B
authors.initials: B
authors.lastname: Liu
authors.forename: Q
authors.initials: Q
authors.lastname: Li
authors.forename: G L
authors.initials: GL
authors.lastname: Zhang
authors.forename: L
authors.initials: L
authors.lastname: Hu
authors.forename: Zy
authors.initials: Z
authors.lastname: Li
authors.forename: D
authors.initials: D
authors.lastname: He
mesh_terms: D000293:Adolescent; D000328:Adult; D001416:Back Pain / Q000209:etiology; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult