Effects of pedicle screw internal fixation via different approaches in patients with thoracic and lumbar fractures

Objective To compare the effects of modified Wiltse approach and percutaneous pedicle screw fixation on stress response and function recovery of waist and back in patients with type B (AO type) thoracolumbar fracture.

Methods A total of 103 with thoracolumbar type B fractures were randomly divided into percutaneous group (51 cases, percutaneous pedicle screw technique) and modified group (52 cases, pedicle screw fixation via modified Wiltse approach), and the operation situation and the recovery of waist and back evaluated by Oswestry dysfunction index (ODI) before operation, one month and three months after operation, stress response serum cortisol (Cor), adrenaline (E) and creatine kinase (CK) were detected before and 3 days after operation, related indexes of imaging examinationCobb angle of kyphosis and height ratio of anterior edge of injured vertebral body (AVHR) before and one year after operationand pain degreeby Visual Analogue Scale (VAS) before operation, 1 week and 1 month after operation.

Results Compared with the percutaneous group, the operation time and perioperative fluoroscopy time in the modified group were shorter, and the blood loss during the operation was less (P < 0.05); the ODI scores at 1 month, 3 months after surgery of the two groups were lower than before surgery, and the modified group was lower than the percutaneous group (P < 0.05); the expressions of serum Cor, E and CK at 3 days after surgery in the two groups were higher than surgery before, but the levels of serum Cor, E and CK in the modified group were lower than those in the percutaneous group(P < 0.05); at 1 year after surgery, Cobb angles in two groups were smaller than before surgery, AVHR was larger than before surgery, and AVHR in the modified group was larger than that in the percutaneous group (P < 0.05); at 1 week and 1 month after surgery, VAS scores in two groups were lower than before surgery, and the modified group had lower VAS score than that in the percutaneous group (P < 0.05).

Conclusion Compared with percutaneous pedicle screw fixation, modified Wiltse approach is beneficial to shorten the operation time and intraoperative fluoroscopy time, and relieve stress response of the body for thoracolumbar type B fracture, which is of great significance to promote recovery of postoperative lumbar and back function as well as physiological anatomy, and relieve the pain of patients.