One‐Year Clinical Outcomes of Minimal‐Invasive Dorsal Percutaneous Fixation of Thoracolumbar Spine Fractures

Abstract

Introduction: Minimal‐invasive instrumentation techniques have become a workhorse in spine surgery and require constant clinical evaluations. We sought to analyze patient‐reported outcome measures (PROMs) and clinicopathological characteristics of thoracolumbar fracture stabilizations utilizing a minimal‐invasive percutaneous dorsal screw‐rod system. Methods: We included all patients with thoracolumbar spine fractures who underwent minimal‐invasive percutaneous spine stabilization in our clinics since inception and who have at least 1 year of follow-up data. Clinical characteristics (length of hospital stay (LOS), operation time (OT), and complications), PROMs (preoperative (pre‐op), 3‐weeks postoperative (post‐op), 1‐year postoperative: eq5D, COMI, ODI, NRS back pain), and laboratory markers (leucocytes, c‐reactive protein (CRP)) were analyzed, finding significant associations between these study variables and PROMs. Results: A total of 68 patients (m: 45.6%; f: 54.4%; mean age: 76.9 ± 13.9) were included. The most common fracture types according to the AO classification were A3 (40.3%) and A4 (40.3%), followed by B2 (7.46%) and B1 (5.97%). The Median American Society of Anesthesiologists (ASA) score was 3 (range: 1–4). Stabilized levels ranged from TH4 to L5 (mean number of targeted levels: 4.25 ± 1.4), with TH10‐L2 (12/68) and TH11‐L3 (11/68) being the most frequent site of surgery. Mean OT and LOS were 92.2 ± 28.2 min and 14.3 ± 6.9 days, respectively. We observed 9/68 complications (13.2%), mostly involving screw misalignments and loosening. CRP increased from 24.9 ± 33.3 pre-op to 34.8 ± 29.9 post‐op (p < 0.001), whereas leucocyte counts remained stable. All PROMs showed a marked significant improvement for both 3‐week and 1‐year evaluations compared to the preoperative situation. Interestingly, we did not find an impact of OT, LOS, lab markers, complications, and other clinical characteristics on PROMs. Notably, a higher number of stabilized levels did not affect PROMs. Conclusions: Minimal‐invasive stabilization of thoracolumbar fractures utilizing a dorsal percutaneous approach resulted in significant PROM outcome improvements, although we observed a complication rate of 13.2% for up to 1 year of follow‐up. PROMs were not significantly associated with clinicopathological characteristics, technique‐related variables, or the number of targeted levels.