A Comparison of the Mini-Open Wiltse Approach with Pedicle Screw Fixation and the Percutaneous Pedicle Screw Fixation for Neurologically Intact Thoracolumbar Fractures

BACKGROUND The thoracolumbar AO type A3 fracture is an incomplete burst fracture, which affects one vertebral body endplate. The objective of this study was to determine which of two minimal invasive techniques was more suitable for A3 fractures based on clinical and radiographic results. MATERIAL AND METHODS We studied 112 patients with A3 subtype fractures without neurological deficits. A total of 63 patients received percutaneous pedicle screw fixation (PPSF), and 49 patients were treated using mini-open Wiltse approach with pedicle screw fixation (MWPSF). The clinical outcomes, surgery-related results, and the pre-operative and post-operative radiological findings were compared between the two groups. RESULTS The length of incision, intra-operative blood loss, post-operative hospitalization time, visual analog score (VAS), Oswestry disability index (ODI), and accuracy rate of pedicle screw placement were compared between the PPSF and MWPSF groups, with no significant differences found (p>0.05). However, the vertebral body angle (VBA) and Cobb's angle in the MWPSF group was much better than in the PPSF group (p<0.05). The operating time and C-arm exposure time of the MWPSF group were significantly lower than the PPSF group (p<0.05). The operative and post-operative costs of the PPSF group were significantly higher than the MWPSF group (p<0.05). CONCLUSIONS Our study found no significant differences in some clinical outcomes between the two groups. Both treatments were safe and effective for A3 subtype fractures. Nevertheless, given the radiation exposure, reduction of kyphosis, special equipment required, learning curve and hospitalization costs associated with PPSF, we concluded that MWPSF was a better choice for A3 subtype fractures.