Symbol: Pedicle screw placementviaparaspinal approachversusconventional approach for the treatment of thoracolumbar vertebral fracture

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Abstract

BACKGROUND:

Pedicle screw and rod fixation system is a common method for the treatment of thoracolumbar vertebral fracture. Conventional approach is the midline approach which needs to cut paraspinal muscle widely, and parts of patients suffer from back pain after surgery.

OBJECTIVE:

To observe the clinical outcome and paraspinal muscle injury after the treatment of thoracolumbar fractures via paraspinal approach and conventional approach.

METHODS:

A total of 45 patients with thoracolumbar fractures were selected from Department of Orthopedics, Affiliated Provincial Hospital of Anhui Medical University during June 2010 to June 2012. According to Denis fracture classification, there were 11 compression fractures and 34 burst fractures with intact posterior column, and the spinal canal occupied for less than 1/3. American Spinal Injury Association grade was E-class with no neurological symptoms. Randomly, 21 patients adopted paraspinal approach and the other 24 patients underwent the conventional approach. The perioperative parameters and intervertebral indicators were compared between two groups. The visual analogue scale score and Japanese Orthopaedic Association score were analyzed postoperatively, and the postoperative and 1, 3, and 5 days preoperative serum level of creatine kinase were compared, also multifidus muscle electromyography assessment was adopted during follow-up.

RESULTS AND CONCLUSION:

There was no significant difference in the Cobb's angle restoration between two groups, but the operation time, blood loss, volume of drainage, serum level of creatine kinase and postoperative visual analogue scale score in the paraspinal approach group were significantly lower than those in the conventional approach group (P < 0.05). The Japanese Orthopaedic Association score at 6 months postoperatively in the paraspinal approach group was lower than that in the conventional approach group, but the difference was not statistically significant (P > 0.05). The multifidus muscle electromyography assessment after 6 months showed that the fibrillation potentials in the paraspinal approach group were less than that in the conventional approach group, and the difference was statistically significant (P < 0.05). Paraspinal approach has satisfactory curative effect with the advantages of less trauma and bleeding as well as shorter operation time.

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