title: Open versus Percutaneous Stabilization of Thoracolumbar Spine Fractures: A Short-Term Functional and Radiological Follow-up.
abstract: OBJECTIVE
  A prospective cohort study evaluates the functional and radiological outcome of thoracolumbar spine fractures treated either with open or percutaneous dorsal instrumentation. In recent years, several studies advocate percutaneous stabilization of spinal fractures in patients without neurological deficits. However, it is still debated whether percutaneous stabilization is superior to open dorsal instrumentation in spinal trauma.
  
  
  METHODS
  This study was performed between 2010 and 2012 at a Level 1 trauma center. Patients treated either with an open or a percutaneous dorsal instrumentation for traumatic fractures of the thoracolumbar spine (T11 to L2) were included. Fracture morphology, screw positioning and clinical parameters were analyzed. Standardized questionnaires (VAS-spine-score; Oswestry-disability-score; SF-36) and follow up radiographs were performed.
  
  
  RESULTS
  Overall 72 patients (29 percutaneous; 43 open) could be included. The surgical and the early postsurgical course were similar between both groups. Furthermore the operative approach had no influence on the functional and radiological outcome one year after surgery, but the questionnaires showed moderate impairments within both groups. Also both groups showed a significant loss of reduction after the first postoperative month (p < 0.01). Within the open group a significantly higher amount of fracture reduction (p < 0.01) and a significantly reduced intraoperative radiation exposure was seen (open 105.9 sec.; percutaneous 143.1 sec; p < 0.05); whereas the percutaneous approach was associated with significantly reduced intraoperative blood loss (open 2.2 g/dl; percutaneous 1.2 g/dl; p < 0.001).
  
  
  CONCLUSIONS
  The functional and the radiological outcome of both groups was comparable one year after trauma. Minor advantages of the percutaneous system was less blood loss, whereas the open approach was associated with a significantly higher amount of initial reduction and significantly less intraoperative radiation exposure. Independent from the type of posterior fixation loss of reduction was already significant in the early postoperative course.
authors.affiliation: University of Aachen Medical Center, Department of Orthopaedic Trauma, Aachen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Pishnamaz
authors.forename: S
authors.initials: S
authors.lastname: Oikonomidis
authors.forename: M
authors.initials: M
authors.lastname: Knobe
authors.forename: K
authors.initials: K
authors.lastname: Horst
authors.forename: H-C
authors.initials: HC
authors.lastname: Pape
authors.forename: P
authors.initials: P
authors.lastname: Kobbe
mesh_terms: D016063:Blood Loss, Surgical; D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D011446:Prospective Studies; D000069079:Radiation Exposure / Q000009:adverse effects; D016103:Spinal Fractures / Q000601:surgery*; D016896:Treatment Outcome