Risk Factors of Correction Loss After Percutaneous Reduction and Fixation for Thoracolumbar Burst Fracture: A One-Year Follow-Up Study

TL;DR

This study identifies preoperative vertebral wedge angle as a risk factor for correction loss after spinal surgery for thoracolumbar burst fractures.

Contribution

The study identifies preoperative vertebral wedge angle as a novel risk factor for correction loss after percutaneous spinal fixation.

Findings

A larger preoperative vertebral wedge angle was significantly associated with correction loss.

Postoperative vertebral wedge angle improvement was not maintained in patients with correction loss.

Factors like BMI, osteoporosis, and surgical time did not significantly affect correction loss.

Abstract

Study design and purpose: This is a single-center retrospective observational study. The study aimed to find out the risk factors for correction loss after percutaneous reduction and fixation for thoracolumbar burst fractures.

Materials and methods: This study included 25 patients who underwent percutaneous reduction and pedicle fixation for thoracolumbar burst fractures from 2017 to 2024. Radiographic assessments were performed to identify vertebral wedge and focal kyphosis angles pre-operatively, post-operatively, and at one-year follow-up for all patients. Then, patients were divided into two groups: no correction loss (Group NCL), which had <5 degrees of correction loss, and correction loss (Group CL), which had 5 and >5 degrees of correction loss at one-year follow-up. Between the two groups, radiological parameters, BMI, osteoporosis, long/short construct, surgical time, intraoperative blood loss, postoperative complications, and revision surgery rate were evaluated. In comparing the groups, the Mann-Whitney U test analysis was used for continuous variables, while the Fisher exact test was used for dichotomous variables.

Results: The pre-operative wedge angle was statistically greater in Group CL (23.1 ± 6.8, 17.8 ± 6.7 degrees, p<0.001, mean difference 5.3, 95% confidence interval 19.7, 26.5). The final vertebral wedge angle in Group NCL statistically improved and was maintained at the final follow-up (p<0.001). The post-operative vertebral wedge angle in Group CL was significantly improved post-operatively (p<0.001), but decreased at final follow-up (p<0.001). The BMI, osteoporosis, long/short construct, surgical time, intraoperative blood loss, and postoperative complications were not significantly different. No revision surgery was observed in either group.

Conclusions: Percutaneous reduction and fixation for thoracolumbar fractures could correct and maintain good spinal alignment. The preoperative large vertebral wedge angle was the only risk factor for correction loss. Short fixation, osteoporosis, and vertebral comminution were not significant risk factors in our study.

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