A prospective study about paraspinal approach and conventional approach for the thoracolumbar fractures

LIN Zi-feng; WANG Wan-ming; WEI Mei-yang

doi:10.3969/j.issn.1009-4237.2013.06.019

Abstract：Objective To compare the clinical outcome and the impacts of paraspinal approach and con-ventional approach in treating thoracolumbar fractures without neurological symptoms .Methods From Jul.2011 to Jul.2012,eighty-two patients who suffered from thoracolumbar fractures without neurological symptoms and need posterior short-segment pedicle screws fixation were included .These patients were randomly divided into 2 groups:paraspinal approach group (39 cases) and conventional approach group (22 cases).Clinical effects were accessed and measured;the pathological changes of paravertebral muscle tissue which was resected at 1 year after operation were observed and compared between the two groups .Results The surgical time,surgical blood loss,volume of re-sidual cavity,surgical draining loss,postoperative VAS (visual analogue scale) scores were lower in the paraspinal approach group than those in the conventional approach group (P<0.05).There was no difference in the length of incision between the two groups (P>0.05).The CK(Creatine kinases)value at 2 days and 3 days postoperatively was significantly lower in the paraspinal approach group than that in the conventional approach group (P<0.01). However,the CK(Creatine kinases)value recovered to normal level at 1 week postoperatively,exhibiting no statistical difference(P>0.05).Both surgical methods could obviously correct the kyphosis angle and the compression verte -bral height.There was no significant difference in the average height of anterior and posterior border of vertebral body and the Cobb angle between postoperatively and preoperatively (P>0.05).The pathological observations showed atrophy of muscle,formation of scar and deposition of fat in the conventional approach group ,whereas in the paraspinal approach group ,these conditions were notably alleviated .Conclusion The paraspinal approach for trea-ting thoracolumbar fractures without neurological symptoms can effectively recover the height of vertebral body and correct the kyphosis.Compared with the conventional approach ,the paraspinal approach has the advantages of mini-invasiveness,less bleeding,short surgical time,no injury to the paraspinal muscles and less pain to the back muscle .