Abstract：Objective To estimate the effect of pedicle screw fixation of thoracolumbar fractures via paraspinal approach and compare it with the conventional posterior midline approach. Methods Forty-two cases of thoracolumbar monosegmental fractures subjected to single posterior pedicle screw fixation and reduction from December 2008 to May 2010 were included in the study. Among the patients, 19 cases were operated through paraspinal muscular-sparing approach (paraspinal approach group) and 23 cases through posterior midline surgical approach (conventional approach group). Surgical incision length, operation time, intraoperative blood loss, postoperative drainage volume, postoperative hospital stay, pre- and post-operative VAS and other perioperative indices as well as fracture reduction outcome were compared between the two groups. Oswestry disability index (ODI) was assessed after operation. Results There were no statistical differences between the two groups in aspects of surgical incision length, operation time, postoperative hospital stay, height restoration of fractured vertebra (P>0.05), but intraoperative blood loss (148.5±26.5) ml, postoperative draining loss (72.9±17.3) ml, postoperative VAS (1.1±0.3) points and ODI (13.4±2.7) points in paraspinal approach group showed statistical differences from those in conventional approach group (P<0.05). Conclusion Paraspinal muscle-sparing approach is characterized by minor trauma, less bleeding, slight pain and quick recovery as compared with conventional posterior midline approach and hence may be the preferred choice for the treatment of thoracolumbar fracture without spinal canal decompression.
REN Zhong-ming,WU Hong-fei,ZHANG Yuan et al. Paraspinal approach versus conventional approach in pedicle screw fixation of thoracolumbar fractures[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(9): 845-848.
［3］Yang HY, Gu R, Deng SC, et al. Three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar fracture. Spine, 2010, 35(8):E295-E302.
［5］Ward SR, Kim CW, Eng CM, et al. Architectural analysis and intraoperative measurements demonstrate the unique design of the multifidus muscle for lumbar spine stability. J Bone Joint Surg (Am), 2009, 91(1):176-185.
［6］Boelderl A, Daniaux H, Kathrein A, et al. Danger of damaging the medial branches of the posterior rami of spinal nerves during a dorsomedian approach to the spine. Clin Anat, 2002, 15(2):77-81.
［7］Stevens KJ, Spenciner DB, Griffiths KL, et al. Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pression studies. J Spinal Disord Tech, 2006, 19(2):77-86.
［8］Wiltse LL, Bateman JG, Hutchinson RH, et al. The paraspinal scarospinalis-splitting approach to the lumbar spine. J Bone Joint Surg (Am), 1968, 50:919-926.
［9］Jiang R, Wu H, Wang J. Paraspinal approach for thoracolumbar fracture. Chin J Traumatol, 2011, 14(1):3-6.
［10］Wild MH, Glees M, Plieschnegger C, et al. Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fracture: a comparison of minimally invasive percutaneously and conventionally open treated patients. Arch Orthop Trauma Surg, 2007, 127(5):335-343.
