Open vs Percutaneous Pedicle Instrumentation for Kyphosis Correction in Traumatic Thoracic and Thoracolumbar Spine Injuries

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Figure 1
Study population selection criteria demonstrating included and excluded patients. A total of 360 patients were reviewed, and 91 were included in the study with 70 follow-up imaging. TL, thoracolumbar.
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Figure 2
Comparison of mean kyphosis angle at preoperative, postoperative, and follow-up period between open and percutaneous pedicle instrumentation. MIS, minimally invasive surgery.

Table 1

Comparison of patient characteristics between open and PPI cohorts.

Characteristics	Open	PPI	P Value^a
No. of patients	65 (71.4)	26 (28.6)
No. of patients with follow-up	50 (77)	20 (77)
Age, mean ± SD	39.2 ± 14.8	38.4 ± 17.4	0.65
Body mass index (kg/m²)	26.3 ± 5.4	25.3 ± 3.5	0.67
Overweight/obese	36 (55.4)	14 (53.9)	>0.99
Sex—male	44 (67.7)	17 (65.4)	>0.99
Charlson Comorbidity Index	0.35 ± 0.8	0.69 ± 1.5	0.37
Other body trauma	57 (87.7)	22 (84.6)	0.74
Neurological status
Intact	31 (47.7)	19 (73.1)	0.09
Incomplete injury	13 (20.0)	3 (11.5)
Complete injury	21 (32.3)	4 (15.4)
American Society of Anesthesiologists score
1	10 (15.4)	4 (15.4)	0.21
2	27 (41.5)	15 (57.7)
3	21 (32.3)	4 (15.4)
4	6 (9.2)	1 (3.9)

Table 2

Comparison of radiographic characteristics and surgical variables between open and PPI patients.

Data presented as n (%) unless otherwise noted.
aIndicates statistically significant values with P < 0.05.
bAdapted from: Vaccaro AR, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):2028–2037.
cShort-segment construct extends from 1 vertebral level above to 1 level below injury and long-segment anything with more than 3 motion segments.
PPI, percutaneous pedicle instrumentation.

Table 3

Comparison of angular correction and loss of correction between open and PPI in all patients and selected patient subgroups.

Variable	Angular Correction^a(°)	P Value^b	Loss of Correction^c (°)	P Value^b
All patients
Open, mean ± SD (95% CI)	11 ± 9 (9–13)	0.81	1 ± 2 (0–2)	0.82
PPI	11 ± 10 (6–15)	0.81	1 ± 3 (0–2)	0.82
Overweight and obese patients only
Open	9 ± 8 (6–12)	0.44	1 ± 3 (0–2)	0.74
PPI	7 ± 8 (2–11)	0.44	1 ± 3 (−1 to 3)	0.74
Thoracolumbar (T10-L2) fractures only
Open	15 ± 8 (12–18)	0.25	1 ± 2 (0–2)	0.85
PPI	12 ± 10 (7–16)	0.25	1 ± 3 (0–2)	0.85
AO type A compression fractures only^d
Open	8 ± 10 (3–13)	0.66	1 ± 3 (0–3)	0.92
PPI	7 ± 8 (2–12)	0.66	2 ± 3 (−1 to 4)	0.92
AO type B tension-band injuries only
Open	12 ± 17 (9–15)	0.29	1 ± 3 (0–3)	0.38
PPI	16 ± 10 (9–22)	0.29	0 ± 2 (−1 to 2)	0.38
AO type A and B combined
Open	10 ± 9 (8–13)	0.86	1 ± 3 (0–2)	0.78
PPI	11 ± 10 (7–15)	0.86	1 ± 3 (0–2)	0.78

aAngular correction is the differences between preoperative and immediate postoperative radiograph Cobb angle.
bIndicates statistically significant values with P < 0.05.
cLoss of correction is the difference between immediate postoperative and last follow-up radiograph Cobb angle.
dAdapted from: Vaccaro AR, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):2028–2037.
PPI, percutaneous pedicle instrumentation.

Table 4

Comparison of angular correction and loss of correction by patient subgroups regardless of surgical technique used.

aAngular correction is the differences between preoperative and immediate postoperative radiograph Cobb angle.
bIndicates statistically significant values with P < 0.05.
cLoss of correction is the difference between immediate postoperative and last follow-up radiograph Cobb angle.
dAdapted from: Vaccaro, A. R., et al. (2013). AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976), 38(23), 2028–2037.