Pedicle screw fixation with a novel external frame for thoracolumbar fractures: A comparative study

Summary: Objective: Controversy exists in treatment of thoracolumbar fractures without neurologic deficits. Percutaneous pedicle screw implantation with external frame is a less invasive procedures. This study was conducted to compared outcomes of percutaneous pedicle screws with a novel external fixation (micro-motional adjustable external fixator-MAEF) and open surgery for thoracolumbar fracture without neurologic deficits. Methods: Between October 2017 to October 2018, 42 patients of thoracolumbar fractures without neurologic deficits treated at our trauma center were analyzed retrospectively. The mean age of the patients was 42 years old (range 17–65). Pedicle screw and a novel external frame or open surgery were performed by senior surgeons. Perioperative and radiographic data were collected. Results: There was no significant statistically difference between MAEF and open surgery in demographics and preoperative data. There were statistically significant differences in blood loss intraoperative between the two groups (44.3 ± 15.1 vs 291.1 ± 175.9, p < 0.05). There were statistically significant differences in local kyphosis (LK) (4.9 ± 5.1vs 8.8 ± 5.4, p < 0.05), regional kyphosis (RK) (4.2 ± 3.6 vs 8.3 ± 6, p < 0.05) and segmental kyphosis (SK) (4.3 ± 4.2 vs 8 ± 5.3, p < 0.05) after 12 month between the two groups. There were statistically significant differences in visual analogue scale（VAS） postoperative but 12 month postoperative between the two groups (3.7 ± 1 vs 5.4 ± 0.8, p < 0.05). There were no statistically significant differences in Oswestry disability index（ODI） after 12 months between the two groups (2 ± 1.8 vs 2.7 ± 2.8, p > 0.05). There are 1 complication in MAEF while 3 in open surgery group. Conclusion: The MAEF is a less invasive procedure, which provides reduced bleeding and no necessity of secondary surgery. The technique is effective in the management of thoracolumbar fractures as well as maintaining reduction. It may be a good choice for thoracolumbar fractures without neurological deficits. The translational potential of this article: This study showed that the new spinal external frame was as effective as open reduction and internal fixation in the treatment of thoracolumbar fractures, but had more advantages in postoperative kyphotic deformity. We will continue to investigate its advantages in open fractures, multiple jumping spine fractures and postoperative recovery.