Percutaneous fixation as definitive care for AO spine type B thoracolumbar fractures in polytrauma patients.

Abstract

Percutaneous pedicle screw fixation is considered the standard treatment for thoracolumbar compression fractures. Its role in unstable injuries with anterior or posterior tension band lesion (AO Spine Type B) remains controversial, as open posterior fusion is traditionally recommended. In polytrauma patients, associated injuries and hemodynamic instability may increase the morbidity of open surgery and delay definitive treatment. In this setting, percutaneous stabilization offers a minimally invasive damage-control strategy, allowing restoration of spinal stability and early mobilization of the patient. This study evaluated the safety and mid-term clinical and radiological outcomes of percutaneous posterior stabilization in polytrauma patients with AO Spine Type B thoracolumbar fractures. A retrospective analysis was performed on 43 consecutive polytrauma patients who underwent percutaneous pedicle screw fixation for a total of 48 thoracolumbar AO Spine type B fractures. Inclusion criteria required a minimum follow-up of 12 months. Patients with associated vertebral body fractures scoring ≥7 on the Load Sharing Classification were excluded. Operative time, blood loss and perioperative complications were recorded. Radiological follow-up assessed alignment maintenance, implant failure and hardware-related complications. Thirty-two patients were male, while the mean age was 47.9 years. Fracture distribution was as follows: B1 (27.1%), B2 (37.5%), and B3 (35.4%). No intraoperative or perioperative complications occurred. At a mean follow-up of 2.6 years, no proximal junctional kyphosis, mechanical implant failure, or infections were observed. Two patients (4.6%) showed an asymptomatic mild peri-screw osteolysis at one year. No cases required a revision surgery. In polytrauma patients, percutaneous pedicle screw fixation appears to be a safe and effective alternative to open fusion for AO Spine Type B fractures. The minimally invasive approach was associated with low surgical morbidity and enabled early mobilization. Mid-term outcomes support its role as definitive treatment, demonstrating maintained sagittal alignment and absence of clinically relevant hardware complications. Percutaneous pedicle screw fixation represents a reliable low-impact damage-control strategy in polytrauma patients with AO Spine Type B thoracolumbar fractures and showed favourable mid-term results consistent with definitive management.