Comparison of a Paraspinal Approach with a Percutaneous Approach in the Treatment of Thoracolumbar Burst Fractures with Posterior Ligamentous Complex Injury: a Prospective Randomized Controlled Trial

OBJECTIVE: This prospective randomized controlled study compared the efficacy and safety of two paraspinal muscle-sparing surgical approaches for the management of neurologically intact patients with thoracolumbar burst fractures and posterior ligamentous complex injuries. METHODS: Patients were randomized to undergo either percutaneous (n = 31) or paraspinal (n = 30) fluoroscopically-guided pedicle screw-rod fixation, and were followed for >= 3 years. Preoperative postural reduction was attempted in all patients. RESULTS: The percutaneous approach was associated with significantly less intraoperative blood loss and shorter duration of surgery and hospitalization, as well as less pain and better functional recovery at 3 months after surgery compared with the paraspinal approach. Paraspinal surgery resulted in significantly better correction of kyphosis and restoration of vertebral height compared with percutaneous surgery. There were no differences in long-term clinical outcomes between the two groups. CONCLUSIONS: The minimally invasive percutaneous approach appears to be better in cases of successful postural reduction. The paraspinal approach results in better surgical correction and is, therefore, recommended for patients without successful postural reduction.