Comparison of short- and long-term efficacy between percutaneous and open pedicle screw fixation for thoracolumbar...

To compare the short-term and long-term efficacy of percutaneous pedicle screw fixation (PPSF) and open pedicle screw fixation (OPSF) in treating thoracolumbar vertebral fracture (TVF).

We performed a retrospective cohort analysis of 158 patients with TVF. Patients were categorized into PPSF (n = 86) and OPSF (n = 72) groups based on the surgical procedure. Perioperative parameters, wound healing, functional outcomes (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), radiological parameters (percentage of anterior vertebral body height [PAVBH] and Cobb angle), and complications were collected at 7 days, 6 months, and 12 months postoperatively. Statistical analysis included independent t-tests, repeated measures ANOVA for longitudinal data, and multivariate linear regression analysis to identify independent predictors of long-term outcomes.

The PPSF group demonstrated superior perioperative outcomes, including shorter operative time (P = 0.008), less blood loss, shorter hospital stay, and faster wound healing (all P < 0.001). Repeated-measures ANOVA revealed significant group-by-time interactions for VAS, ODI, PAVBH, and Cobb angle (all P < 0.01). The PPSF group consistently showed better pain control and functional recovery from 6 months onwards, and superior early radiological correction. During the 12-month follow-up, despite radiological outcomes were comparable, the PPSF group maintained significantly lower VAS and ODI scores (both P < 0.001). Multivariate regression analysis confirmed PPSF as an independent factor associated with better 12-month ODI (β = -5.19, P < 0.001) and VAS scores (β = -0.56, P < 0.001). The overall complication rate was significantly lower in the PPSF group (P = 0.028).

PPSF can reduce surgical trauma, promote faster recovery, and improve functional outcomes in patients with TVF, suggesting it as a promising alternative to OPSF. Further studies are needed to confirm these findings and assess long-term efficacy.