Background: Thoraco-lumbar burst fractures are considered one of the most controversial and challenging fracture types to manage. Aim of this study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation in the treatment of traumatic thoraco-lumbar burst fractures with spinal injury.

Methods: A prospective comparative study including thirty patients with thoraco-lumbar burst fracture were equally divided into an open pedicle screw fixation (OPSF) group and a percutaneous pedicle screw fixation (PPSF) group. Demographic characteristics, clinical and radiological outcomes, and adverse events were assessed and compared between the 2 groups.

Results: Demographic and clinical features including age, gender, fracture level, mechanism of injury and neurological status in both groups were not significantly different (all p>0.05). The PPSF group exhibits significantly lower operative time, intra-operative blood loss, and hospital stay compared with the OPSF group (all p<0.05). There was no significant difference in the sagittal cobb′s angle (CA), fractured vertebral body angle (VBA) and anterior vertebral body height (AVBH) on pre-operative, immediate post-operative and final follow up between the two surgical techniques (all p>.05). Visual analogue scale (VAS) remarkably decreased in both groups after surgery but difference was not statically significant (p=0.808). Common postoperative complications in both groups were superficial infections, pressure ulcer and urinary tract infection (UTI) worsening. Hardware failure was seen only in one case of PPSF group.

Conclusions: Patients with thoraco-lumbar burst fractures can be effectively managed with PPSF or OPSF. There were no significant differences in radiological and clinical outcomes and post-op complications between 2 groups but blood loss, operative time and hospitalization stay were less in percutaneous group, which may represent a potential benefit.

Keywords: Thoraco-lumbar burst fracture, OPSF, PPSF, Posterior approach, Prospective comparative study