Injury - 2026-09-09 - Journal Article
Longitudinal radiographic comparison of percutaneous and open pedicle screw fixation for thoracolumbar burst fractures: A two-year follow-up study.
Wung CH, Chang CY, Hsu CC, Wu RW, Yang FS, Lu ML, Chen HT
Topics
Key Takeaway
PPSF achieved a significantly lower Cobb angle than OPSF at two years (6.7° vs. 9.1°, P=0.049), with a difference that was not detectable at one year.
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Summary
This retrospective cohort compared radiographic outcomes of PPSF versus OPSF for thoracolumbar burst fractures treated with short-segment posterior fixation over two years. PPSF produced significantly less intraoperative blood loss (61.9 vs. 262.7 mL, P<0.001) and a lower Cobb angle at two years (6.7° vs. 9.1°, P=0.049), though no between-group difference existed at one year. LLA, operative time, hospital stay, and revision rates did not differ between groups.
Key Limitation
The 2.4° between-group Cobb angle difference at two years, while statistically significant, falls below the generally accepted minimum clinically important difference for sagittal alignment, limiting the functional relevance of this radiographic finding.
Original Abstract
PURPOSE
While percutaneous pedicle screw fixation (PPSF) and open pedicle screw fixation (OPSF) demonstrate comparable clinical outcomes at 1-year follow-up, the longitudinal evolution of sagittal alignment beyond one year remains poorly characterized. This study compared the longitudinal radiographic outcomes of PPSF and OPSF in patients with thoracolumbar burst fractures (TLBF) over a two-year follow-up period.
METHODS
This retrospective cohort study included 54 patients with TLBF who underwent short-segment posterior fixation using either PPSF (n = 29) or OPSF (n = 25). The primary radiographic outcome was Cobb angle. Secondary outcomes included lumbar lordosis angle (LLA), operative time, intraoperative blood loss, postoperative hospital stay, and revision surgery. Serial radiographic evaluations were performed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively.
RESULTS
Baseline demographic characteristics and preoperative radiographic parameters were comparable between groups. PPSF was associated with significantly lower intraoperative blood loss than OPSF (61.9 ± 34.8 mL vs. 262.7 ± 205.1 mL, P < 0.001), whereas operative time and postoperative hospital stay did not differ significantly. Both groups demonstrated significant reductions in Cobb angle over the two-year follow-up. No significant between-group differences in Cobb angle were observed during the first year postoperatively. However, the PPSF group demonstrated a significantly lower Cobb angle than the OPSF group at two years (6.7° ± 3.5° vs. 9.1° ± 6.4°, P = 0.049). LLA remained comparable between groups throughout follow-up (P = 0.523). No construct failure or revision surgery occurred during the two-year follow-up period.
CONCLUSIONS
Serial radiographic evaluation demonstrated that differences in sagittal alignment became apparent only after the first postoperative year. Compared with OPSF, PPSF achieved lower intraoperative blood loss and superior two-year Cobb angle outcomes. These findings underscore the importance of longitudinal radiographic follow-up when evaluating fixation strategies for thoracolumbar burst fractures.