Abstract
Objectives Percutaneous pedicle instrumentation (PPI) has been used for the treatment of thoracic and thoracolumbar (TL) trauma. However, the ability of PPI to correct significant post-traumatic kyphosis requires further investigation. The objective of this study is to compare the amount of kyphosis correction achieved by PPI vs the traditional open posterior approach in patients presenting with significant kyphotic deformity following traumatic thoracic and TL spine injuries.
Methods Following Institutional Review Board approval, patients who underwent surgery for thoracic (T1-T9) or TL (T10-L2) fractures with at least 15° of focal kyphosis in a 5-year period were included in this study. Patients were separated into 2 cohorts based on surgical technique: traditional open posterior approach and minimally invasive PPI. Kyphosis correction was measured using Cobb angle 1 vertebrae above and 1 below the level of injury on sagittal preoperative computed tomography image, immediate and follow-up postoperative upright lateral radiographs. Initial degree of correction and loss of correction at the final follow-up were compared.
Results Of 91 patients included, 65 (71%) underwent open surgery and 26 (29%) underwent PPI. Open patients had 11° (95% CI, 9°–13°) of immediate correction compared with 11° (95% CI, 6°–15°) for PPI (P = 0.81). Follow-up data were available for 70 patients with a median of 105.5 days. Both groups had 1° (95% CI, 0°–2°) of loss of correction at follow-up (P = 0.82). Regardless of surgical technique, obesity (>30 kg/m2) and AO type-A compression fractures had significantly less correction. For each unit of body mass index, there was a 0.75° decrease in correction achieved (P < 0.0001). Other factors did not influence the degree of correction.
Conclusions PPI techniques provide equivalent postoperative angular correction and maintenance of correction compared with open surgery in thoracic and TL trauma patients.
Clinical Relevance This study provides evidence for spine surgeons to utilize either technique for treating significant traumatic kyphotic deformity.
Level of Evidence Therapeutic 3.
- spine trauma
- thoracolumbar
- open spine surgery
- percutaneous pedicle instrumentation
- kyphosis correction
- post-traumatic deformity
Footnotes
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests Daniel Cavanaugh reports consulting fees from AlphaTec. Eugene Koh reports consulting fees from Biomet. Dan Gelb reports royalties or licenses from DePuy Synthes; payment or honoraria from DePuy Synthes (lecturer/speaker) and AO Spine North America (course faculty/lecturer); and stock from the Advanced Spinal Intellectual Property. Steven Ludwig reports royalties or licenses from Theime and Quality Medical Publishers, DePuy Synthes Spine and K2M/Stryker; consulting fees from DePuy Synthes Spine and K2M/Stryker; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or education events from AO Spine North America; stock or stock options from Innovaite Surgical Designs and Advance Spinal Intellectual Property; and a leadership or fiduciary role in the following groups: Society for Minimally Invasive Spine Surgery, Cervical Spine Research Society, American Board of Orthopaedic Surgery, Maryland Development Corporation, Journal of Spinal Disorders and Techniques, The Spine Journal, Contemporary Spine Surgery, and Nuvasive. The remaining authors have no disclosures.
Ethics Approval Institutional Review Board approval was obtained for this study (HP-00082698).
- This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2022 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.