Longitudinal radiographic comparison of percutaneous and open pedicle screw fixation for thoracolumbar burst fractures: A two-year follow-up study.

Abstract

While percutaneous pedicle screw fixation (PPSF) and open pedicle screw fixation (OPSF) demonstrate comparable clinical outcomes at 1-year follow-up, the longitudinal evolution of sagittal alignment beyond one year remains poorly characterized. This study compared the longitudinal radiographic outcomes of PPSF and OPSF in patients with thoracolumbar burst fractures (TLBF) over a two-year follow-up period. This retrospective cohort study included 54 patients with TLBF who underwent short-segment posterior fixation using either PPSF (n = 29) or OPSF (n = 25). The primary radiographic outcome was Cobb angle. Secondary outcomes included lumbar lordosis angle (LLA), operative time, intraoperative blood loss, postoperative hospital stay, and revision surgery. Serial radiographic evaluations were performed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Baseline demographic characteristics and preoperative radiographic parameters were comparable between groups. PPSF was associated with significantly lower intraoperative blood loss than OPSF (61.9 ± 34.8 mL vs. 262.7 ± 205.1 mL, P < 0.001), whereas operative time and postoperative hospital stay did not differ significantly. Both groups demonstrated significant reductions in Cobb angle over the two-year follow-up. No significant between-group differences in Cobb angle were observed during the first year postoperatively. However, the PPSF group demonstrated a significantly lower Cobb angle than the OPSF group at two years (6.7° ± 3.5° vs. 9.1° ± 6.4°, P = 0.049). LLA remained comparable between groups throughout follow-up (P = 0.523). No construct failure or revision surgery occurred during the two-year follow-up period. Serial radiographic evaluation demonstrated that differences in sagittal alignment became apparent only after the first postoperative year. Compared with OPSF, PPSF achieved lower intraoperative blood loss and superior two-year Cobb angle outcomes. These findings underscore the importance of longitudinal radiographic follow-up when evaluating fixation strategies for thoracolumbar burst fractures.