28 January 2020 : Clinical Research
Posterior Vertebrectomy via the Unilateral Pedicle or Bilateral Pedicle Approach in the Treatment of Lumber Burst Fracture with Neurological Deficits: A Comparative Retrospective Cohort StudyYuan Xiong1ABC, Hexing Zhang23AC, Shuangqi Yu2B, Wei Chen2CD, Song Wan2BD, Rong Liu4EF, Yi Zhang5AFG, Fan Ding2AEG*
Med Sci Monit 2020; 26:e921754
BACKGROUND: Posterior vertebrectomy with bilateral pedicle approach (BPA) is widely applied in lumber burst fracture (LBF). However, some disadvantages exist, such as a prolonged operation time, extensive soft tissue injury, and excessive blood loss. Posterior vertebrectomy with unilateral pedicle approach (UPA) is a novel technique for decompression of spinal canal. Thus, we explored the potential of UPA to achieve better outcomes than BPA.
MATERIAL AND METHODS: Of 47 patients who underwent posterior vertebrectomy for LBF, 23 patients were treated with UPA and 24 patients were treated with BPA. Clinical and radiographical outcomes were assessed with a follow-up of more than 24 months. Patients were evaluated before and after surgery according to the following parameter: duration of operation (DO), blood loss volume (BLV), the kyphotic angle (KA), the ratio of the height of anterior vertebral edge, the ratio of the sagittal injury, visual analog scale (VAS), Oswestry Disability Index (ODI), and Frankel scores.
RESULTS: The follow-up time ranged from 24 to 37 months (average 26.4 months). The UPA group had significantly decreased DO and BLV (P<0.05). The 2 cohorts showed similar performance at 6 months (P>0.05), 12 months (P>0.05), and 24 months (P>0.05) post-surgery, in terms of parameters including KA, the ratio of the vertebral anterior, the ratio of sagittal damage, Frankel scores, ODI, and VAS.
CONCLUSIONS: UPA and BPA had a similar clinical performance for LBF. However, the shorter DO and lower BLV achieved in the UPA cohort suggested UPA is a better alternative for LBF.
Keywords: Fractures, Bone, operative time, Osteotomy, Spine, Lumbar Vertebrae, Middle Aged, Pedicle Screws, Retrospective Studies, Spinal Fractures, Tomography, X-Ray Computed, Treatment Outcome, visual analog scale
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