A minimally invasive surgical strategy for the treatment of type A thoracolumbar fracture: percutaneous stabilization combined with mini-open anterior intracorporeal bone grafting

Objective: To explore the efficacy of an intracorporeal bone grafting technique in the treatment of type A thoracolumbar fracture. Methods: From Feb 2010 to March 2012, a series of 28 patients type A thoracolumbar fracture with moderate to severe osteoporosis who met our inclusion criteria were treated by a combination of percutaneous pedicle screws posteriorly and intracorporeal grafting through mini-open anterior approaches. Radiographic (kyphosis angle, anterior height percentage of compressed vertebral body) and clinical outcomes (visual analogue scale of back pain, Oswestry disability index) were retrospectively studied to evaluate the patients' outcome in this new procedure. All the patients were followed up with a mean duration of 59.14 +/- 6.4 months. The evaluation for clinical outcomes were excellent and good. Radiograph indicated fracture healing in all cases and there was no instrumentation failure. The anterior height percentage of compressed vertebral body and kyphosis angle were 71.7%+/- 7.2% and 19.6 degrees +/- 3.3 degrees preoperatively, 95.4%+/- 2.8% and 5.5 degrees +/- 2.2 degrees postoperatively, 88.4%+/- 3.7% and 10.3 +/- 2.7 degrees at the 12-month follow-up, 88%+/- 3.7% and 10.8 +/- 2.8 degrees at the last visit. Percutaneous pedicle screw fixation combined with mini-open anterior bone intracorporeal grafting is an effective minimally invasive technique for treating type A thoracolumbar fracture.