Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-60930 | DOI: 10.14744/tjtes.2025.60930

Open Versus Percutaneous Short-Segment Posterýor Instrumentation in Thoracolumbar Junction Burst Fractures

Yücel BÝLGÝN¹, Saltuk Buðra GÜLER², Burak AKESEN^1
1Bursa Uludag University, School of Medicine, Department of Orthopedics and Traumatology, Bursa, Türkiye
²Mamak State Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye

Background: This research aimed to compare the surgical data, clinical and radiological results of patients who underwent surgery using open posterior or percutaneous posterior instrumentation for burst-type spinal fractures in the thoracolumbar junction.

Methods: This study included 73 patients; 43 underwent open posterior instrumentation, and 30 underwent percutaneous posterior instrumentation. In perioperative surgical evaluation, the time between fracture and surgery, the duration of surgery, perioperative blood loss, fluoroscopy duration, and the total length of hospital stay were used. In clinical evaluation, the visual analogue scale (VAS) and the Oswestry disability index (ODI) were used. The preoperative, postoperative, 7th day, and last follow-up values were analyzed.

Results: The fluoroscopy time was significantly longer in the percutaneous surgery group than in the open surgery group (12.77 ± 1.89 minutes vs. 4.33 ± 1.24 minutes; p <0.001). Hospitalization time was significantly longer in the open surgery group (3.79 ± 1.53 days vs. 2.13 ± 0.76 days; p <0.001). VAS scores were significant in the open surgery group and the percutaneous surgery group on the 7th postoperative day (p =0.02) and at the last follow-up (p =0.02). Similarly, lower ODI scores were obtained in the percutaneous group compared to the open surgery group on the 7th postoperative day and at the last follow-up (p <0.001). When evaluated in terms of radiological results, significant postoperative improvements were achieved in both groups regarding AVBHR, but the COBB angle in the sagittal plane, and the differences between the groups were not statistically significant (p=0.07)

Conclusion: According to the results of this study, percutaneous surgery group showed significantly better improvement in VAS and ODI scores on postoperative day 7 and at final follow-up. Similar postoperative improvement was achieved in both groups in terms of AVBHR and sagittal COBB angle.

Keywords: Spinal fractures, surgery, visual analogue scale, blood loss, fluoroscopy

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Torakolomber Bileþke Patlama Kýrýklarýnda Açýk ve Perkütan Kýsa-Segment Posterior Enstrümentasyonun Karþýlaþtýrýlmasý

Yücel BÝLGÝN¹, Saltuk Buðra GÜLER², Burak AKESEN^1
1Bursa Uludað Üniversitesi, Týp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalý, Bursa, Türkiye
²Mamak Devlet Hastanesi, Ortopedi ve Travmatoloji Bölümü, Ankara, Türkiye

Amaç: Bu araþtýrma, torakolomber bileþkede patlama tipi omurga kýrýklarý için açýk posterior veya perkutan posterior enstrümantasyon kullanýlarak ameliyat edilen hastalarýn cerrahi verilerini, klinik ve radyolojik sonuçlarýný karþýlaþtýrmayý amaçlamaktadýr.

Gereç ve Yöntem: Bu çalýþmaya 73 hasta dahil edildi; 43'üne açýk posterior enstrümantasyon, 30'una perkutan posterior enstrümantasyon uygulandý. Perioperatif cerrahi deðerlendirmede, kýrýk ile ameliyat arasýndaki süre, ameliyat süresi, perioperatif kan kaybý, floroskopi süresi ve toplam hastanede kalýþ süresi kullanýldý. Klinik deðerlendirmede, görsel analog skala (VAS) ve Oswestry sakatlýk indeksi (ODI) kullanýldý. Ameliyat öncesi, ameliyat sonrasý 7. gün ve son takip deðerleri analiz edildi. Radyolojik deðerlendirmede anterior vertebral gövde yükseklik oraný(AVBHR) ve COBB açýsý kullanýldý.

Bulgular: Perkütan cerrahi grubunda floroskopi süresi açýk cerrahi grubuna göre anlamlý derecede daha uzundu (12,77 ± 1,89 dakikaya karþý 4,33 ± 1,24 dakika; p <0,001). Hastanede kalýþ süresi açýk cerrahi grubunda anlamlý derecede daha uzundu (3,79 ± 1,53 gün, 2,13 ± 0,76 gün; p <0,001). VAS skorlarý açýk cerrahi grubunda ve perkütan cerrahi grubunda ameliyat sonrasý 7. günde (p = 0,02) ve son takipte (p = 0,02) daha düþüktü. Benzer þekilde, perkütan grupta açýk cerrahi grubuna kýyasla ameliyat sonrasý 7. günde ve son takipte daha düþük ODI skorlarý elde edildi (p <0,001). Radyolojik sonuçlar açýsýndan deðerlendirildiðinde, her iki grupta da AVBHR ve sagital planda COBB açýsý açýsýndan anlamlý postoperatif iyileþmeler elde edildi fakat gruplar arasýndaki fark istatistiksel olarak anlamlý deðildi (p=0,07).

Sonuç: Bu araþtýrmanýn sonuçlarýna göre, perkütan cerrahi grubunda postoperatif 7. günde ve son takipte VAS ve ODI skorlarýnda anlamlý olarak daha iyi iyileþme gözledi. Her iki grupta da AVBHR ve sagital COBB açýsý açýsýndan benzer postoperatif iyileþme elde edildi.

Anahtar Kelimeler: Omurga kýrýklarý, cerrahi, görsel analog skala, kan kaybý, floroskopi

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