title: Percutaneous pedicle screw fixation for thoracolumbar burst fracture: a Singapore experience.
abstract: BACKGROUND
  This study aimed to evaluate the clinical and radiological outcomes, and safety and efficacy of percutaneous pedicle screw fixation (PPSF) in the treatment of thoracolumbar burst fractures.
  
  
  METHODS
  This was a retrospective review of patients with thoracolumbar burst fractures treated with PPSF in a single hospital from 2010 to 2011. Baseline data included patient demographics, mechanism of injuries, fracture level, neurologic status and the number of percutaneous screws inserted. Kyphotic angle correction, vertebral body height restoration and mid-sagittal canal diameter improvement were used to assess radiological outcome. Screw misplacement, operative complications, functional improvement (ASIA score) and pain score on visual analogue scale were used to assess safety and clinical outcomes.
  
  
  RESULTS
  21 patients with 25 thoracolumbar burst fractures were treated with 134 percutaneous screws. There was significant improvement in kyphotic angle correction (mean difference 6.1 degrees, p = 0.006), restoration of anterior and posterior vertebral height (mean difference 19.7%, p < 0.01 and mean difference 6.6%, p = 0.007, respectively) and mid-sagittal canal diameter (mean difference 15.6%, p = 0.007) on discharge. These improvements remained statistically significant at six months post operation for restoration of anterior vertebral body height (mean difference 9.8%, p = 0.05) and mid-sagittal diameter (mean difference 30.0%, p < 0.01).
  
  
  CONCLUSIONS
  In this first local review, we have shown that PPSF is a relatively safe and effective technique for treating selected thoracolumbar burst fractures, and that it yields satisfactory results. However, its long-term outcome and efficacy need to be further evaluated.
authors.affiliation: Department of Neurosurgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore.
authors.forename: Weiren Eugene
authors.initials: WE
authors.lastname: Yang
authors.forename: Zhi Xu
authors.initials: ZX
authors.lastname: Ng
authors.forename: Kok Miang Roy
authors.initials: KM
authors.lastname: Koh
authors.forename: Shiong Wen
authors.initials: SW
authors.lastname: Low
authors.forename: Sein
authors.initials: S
authors.lastname: Lwin
authors.forename: Kim Seng David
authors.initials: KS
authors.lastname: Choy
authors.forename: Edwin
authors.initials: E
authors.lastname: Seet
authors.forename: Tseng Tsai
authors.initials: TT
authors.lastname: Yeo
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011859:Radiography; D012189:Retrospective Studies; D012449:Safety; D012846:Singapore; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries*; D016896:Treatment Outcome