O-arm-assisted percutaneous fixation versus open Wiltse approach for thoracolumbar frac-ture without neurological deficits

Zhou Quan; Cao Chen; Lyu Dongbo; Zhang Jingyi; Chen Shulian; Gao Yanzheng

doi:10.3969/j.issn.1009-4237.2024.11.008

Abstract：Objective To compare the clinical outcomes of thoracolumbar fractures without neurological deficits by percutaneous pedicle screw fixation assisted by O-arm navigation versus open Wiltse approach fixation.Methods Clinical data of 70 cases of thoracolumbar fractures without neurological deficits in our department from Jan.2019 to Jan.2021 were retrospectively analyzed.Based on the method of pedicle screw placement,patients were divided into two groups:O-arm navigation group(n=35,23 males and 12 females aged 27-65 years,mean 45.7 years,with 10 falls from height,18 road traffic injuries,and 7 crush injuries;altogether 140 pedicle screws were in-stalled)and open Wiltse approach group(n=35,19 males and 16 females aged 28-64 years,mean 46.4 years,with 9 falls from height,17 road traffic injuries and 9 crush injuries;altogether 150 pedicle screws were installed).The operation time,radiation dose,pedicle screw placement accuracy and complications were collected.The visual ana-logue scale/score(VAS),Oswestry disability index(ODI),local Cobb angle and anterior edge height of the injured vertebra before surgery,one week/2 days after surgery,and at last follow-up were compared between two groups.Results The operation time(min,73.2±10.0 vs.76.0±11.9),length of hospital stay(d,4.7±0.7 vs.4.5±0.5),total incision length(cm,7.5±0.5 vs.7.7±0.9)and pedicle screw placement accuracy(94.7％vs.97.1％)showed comparable results between two groups(all P＞0.05),but the O-arm navigation group revealed sig-nificantly less intraoperative blood loss(mL,47.2±8.4 vs.73.1±24.6)and radiation dose(cGy/cm2,353.7±90.9 vs.424.2±93.2)than the Wiltse approach group(both P＜0.05).The VAS score at 1 week after surgery was also much lower in the O-arm navigation group than in the Wiltse approach group(1.2±0.4 vs.2.9±0.4,P＜0.05).At last follow-up,the VAS,ODI,local Cobb angle and anterior edge height of the fractured vertebra were sig-nificantly improved than those before surgery(all P＜0.05),but there was no significant difference between the two groups(all P＞0.05).Conclusion O-arm navigation-assisted percutaneous pedicle screw placement and open Wiltse approach fixation are comparable in the treatment of thoracolumbar spinal fractures,but the former can reduce intraoperative blood loss and radiation,and alleviate pain post operatively.