title: Internal fixation with percutaneous kyphoplasty compared with simple percutaneous kyphoplasty for thoracolumbar burst fractures in elderly patients: a prospective randomized controlled trial.
abstract: OBJECTIVE
  The impact of percutaneous internal fixation as a supplement to percutaneous kyphoplasty (PKP) for the management of thoracolumbar burst fractures in elderly patients is unclear. We conducted a clinical controlled trial to investigate the effect and outcomes of this technique in such patients.
  
  
  METHODS
  Forty-three patients over 65 years old with thoracolumbar burst fractures without nerve injuries were enrolled. They were randomly assigned to treatment with simple PKP (control group, n = 22) or percutaneous short-segment pedicle screw internal fixation with PKP (treatment group, n = 21). The patients were followed for at least 2 years postoperatively and were assessed with regard to clinical and radiological outcomes. Clinical outcomes were evaluated mainly with use of visual analog scale (VAS) for pain and the Oswestry Disability Index (ODI) questionnaire. Radiological outcomes were assessed mainly on the basis of Cobb kyphosis angle and loss of kyphosis correction.
  
  
  RESULTS
  There were no significant differences between the two groups with regard to preoperative indices. The treatment group had better VAS scores and greater postoperative improvement on the ODI compared with the control group (P < 0.05). Postoperative kyphosis angle correction in the treatment group was superior to that in the control group, and loss of correction postoperatively was significantly less (P < 0.05). In the control group, two patients suffered refractures of the injured vertebra postoperatively and one had a fracture in the adjacent vertebra. No postoperative complications needing management were noted in either group.
  
  
  CONCLUSIONS
  Compared with simple PKP, percutaneous internal fixation with PKP is a valuable surgical option for the treatment of selected elderly patients with thoracolumbar burst fractures.
authors.affiliation: Department of Orthopedics, 5th Affiliated Hospital, Lishui Central Hospital, Wenzhou Medical College, Lishui, 323000, China.
authors.forename: Dengwei
authors.initials: D
authors.lastname: He
authors.forename: Lijun
authors.initials: L
authors.lastname: Wu
authors.forename: Xiaoyong
authors.initials: X
authors.lastname: Sheng
authors.forename: Qinqin
authors.initials: Q
authors.lastname: Xiao
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhu
authors.forename: Weiyang
authors.initials: W
authors.lastname: Yu
authors.forename: Feijun
authors.initials: F
authors.lastname: Liu
authors.forename: Kejun
authors.initials: K
authors.lastname: Zhu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D058498:Kyphoplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007738:Kyphosis / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D016103:Spinal Fractures / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome