Percutaneous thoracolumbar burst-fracture fixation - does additional anterior support offer significant benefit?

Percutaneous pedicle screw fixation has become a widely adopted technique for treating thoracolumbar burst fractures without neurological deficit, though optimal strategies - particularly regarding anterior support - remain debated. Our objective is to compare kyphotic angle evolution over six months in patients treated with pedicle screws alone versus those receiving additional anterior support via vertebroplasty or kyphoplasty.

We retrospectively analysed 34 neurologically intact patients with thoracolumbar burst fractures treated percutaneously at our institution over the past five years. Patients were divided into two groups: pedicle screw fixation only (n = 15) and screw fixation with anterior support (n = 19). Segmental kyphosis was measured at diagnosis, 24 hours post-op, 3 months, and 6 months. Secondary outcomes included age, sex, visual analog scale (VAS) scores, opioid use, hospital stay, and complications.

Both techniques were effective. At 3 months, mean kyphosis was 7.9° in the screw-only group and 6.6° in the anterior support group. At 6 months, kyphosis converged (7.9° vs. 7.73°, respectively). The only significant difference was observed 24 hours post-op, with greater correction in the anterior support group (p = 0.026). VAS scores improved similarly in both groups, and opioid requirements were low.

While anterior support provided superior immediate radiological correction, this benefit diminished by six months. Both techniques demonstrated comparable long-term outcomes in preserving sagittal alignment and controlling pain in neurologically intact thoracolumbar burst fractures.