Key Takeaways & Executive Findings
- •• Percutaneous minimally invasive pedicle screw fixation across the injured vertebra resulted in significantly shorter operation time, less intraoperative blood loss, smaller incisions, and fewer fluoroscopy exposures compared to trans-injured vertebra fixation. • Both trans-injured and cross-injured fixation techniques effectively restored and maintained vertebral height, corrected kyphotic deformity, and improved functional outcomes at 6 months postoperatively. • No significant differences were observed between the two techniques in terms of radiographic parameters (anterior vertebral height ratio, Cobb angle) and clinical scores (VAS, ODI) at 7 days and 6 months postoperatively. • For patients with AO type A thoracolumbar fractures, normal BMI, and no neurological or posterior ligamentous complex injury, the less invasive cross-injured vertebra fixation is recommended. • The study supports the use of navigation-assisted percutaneous techniques as a safe and effective alternative to open surgery for thoracolumbar fractures.
Abstract
BACKGROUND: Recently, percutaneous minimally invasive pedicle screw fixation systems have become a popular treatment option for thoracolumbar fractures due to ongoing innovation in orthopedic internal fixation devices. Currently, while many studies compare the effectiveness of open pedicle screw fixation through or across the fractured vertebra, fewer studies compare these two methods when using navigation-assisted percutaneous minimally invasive techniques. OBJECTIVE: To compare the clinical efficacy of percutaneous minimally invasive pedicle screw fixation in the treatment of thoracolumbar fracture through and across the injured vertebra. METHODS: A retrospective analysis was performed on 67 patients with single level thoracolumbar fracture without spinal cord nerve injury who were treated in the Department of Spine Surgery, Affiliated Hospital of Yan'an University from October 2021 to June 2023. All of them were treated with percutaneous pedicle screw fixation with the assistance of computer navigation, and were followed up to 6 months after surgery. The injured vertebrae were divided into transinjured vertebrae group (n=35) and cross-injured vertebrae group (n=32). RESULTS AND CONCLUSION: ① There were no significant differences in preoperative general data between the two groups (P > 0.05), indicating comparability. ② Intragroup comparison: In both groups, the anterior vertebral height ratio, Cobb angle, visual analog scale score, and Oswestry disability index at 7 days and 6 months after surgery were significantly improved compared with preoperative values (P < 0.05). ③ Intergroup comparison: The operation time, intraoperative blood loss, incision length, and intraoperative fluoroscopy times in the cross-injured vertebrae group were significantly less than those in the trans-injured vertebrae group (P < 0.05), while there was no significant difference in hospital stay between the two groups (P > 0.05). At 7 days and 6 months after surgery, there were no significant differences in anterior vertebral height ratio, Cobb angle, visual analog scale score, and Oswestry disability index between the two groups (P > 0.05). ④ It is suggested that for patients with single-level thoracolumbar fractures without spinal cord nerve injury, compared with trans-injured vertebra fixation, percutaneous minimally invasive pedicle screw fixation across the injured vertebra has advantages of shorter operation time, less bleeding, smaller surgical incision, and fewer fluoroscopy times. In the medium-term follow-up period, both trans-injured and cross-injured percutaneous minimally invasive fixation can effectively restore and maintain the height of the injured vertebra, correct kyphotic deformity, rebuild spinal stability, and relieve pain, achieving excellent clinical results. For patients with AO type A thoracolumbar fractures with normal body mass index, without spinal cord nerve injury and posterior ligamentous complex injury, the less traumatic cross-injured vertebra percutaneous pedicle screw fixation is recommended.
1. Introduction
Thoracolumbar fractures are among the most common spinal fractures in clinical practice [1-2]. The current principle of surgical treatment is to perform open reduction and internal fixation combined with spinal canal decompression if there is spinal cord compression or neurological symptoms; if there is no nerve injury or only mild injury, percutaneous pedicle screw fixation is usually chosen [3-6]. Compared with traditional posterior open pedicle screw placement, percutaneous pedicle screw technology has the advantages of smaller incisions, less damage to surrounding tissues, shorter operation time, less intraoperative blood loss, and faster postoperative functional recovery [7]. The advent of pedicle screws has provided reliable mechanical support and three-dimensional fixation for the reconstruction of spinal stability [8].
In the past, the mainstream surgical procedure for thoracolumbar fractures was open pedicle screw placement [9-10]. However, with the rapid development of minimally invasive techniques, patients have raised higher requirements for the efficacy and safety of orthopedic surgery. For single-level thoracolumbar fractures, most surgeons prefer percutaneous minimally invasive pedicle screw fixation, which is likely to replace traditional open spinal surgery [11-12].
In the field of percutaneous minimally invasive spine surgery, there is controversy regarding the use of trans-injured versus cross-injured vertebra fixation for thoracolumbar fractures. Some believe that cross-injured vertebra fixation, which indirectly reduces the fracture by connecting the adjacent vertebrae above and below the injured vertebra, may cause a "suspension effect" and "empty shell effect" of the reduced vertebra, leading to failure of the screw-rod system and loss of height restoration [13-14]. Trans-injured vertebra fixation is thought to be superior in restoring the height of the injured vertebra and correcting kyphotic deformity.
Loading authentic research manuscript (Pages 1–5)...
JIA Yingao, QIAO Lina, ZHANG Chao, LIANG Jiawen, XUE Liang, WANG Fei (2026). Comparison of stability of percutaneous minimally invasive pedicle screw insertion in thoracolumbar fractures through and across the injured vertebra under navigation. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21413
Research & Educational Purpose Only:The translations, structured abstracts, analytical annotations, and data reports provided by SinoBioData are intended exclusively for academic research, internal corporate R&D, and educational benchmarking. They do not constitute formal engineering, chemical safety, legal, or professional advice.
Copyright & Intellectual Property Notice: Original copyright of the underlying source articles and experimental data remains with the respective authors, institutions, and original publishing journals. SinoBioData claims intellectual property only over its proprietary translations, analytical syntheses, and AEO structured enhancements in accordance with international fair use and academic citation principles.
Frequently Asked Questions
What are the advantages of cross-injured vertebra fixation over trans-injured vertebra fixation in percutaneous minimally invasive surgery for thoracolumbar fractures?
Cross-injured vertebra fixation resulted in significantly shorter operation time, less intraoperative blood loss, smaller incisions, and fewer fluoroscopy exposures compared to trans-injured vertebra fixation, while achieving similar clinical and radiographic outcomes at 6 months postoperatively.
Which patients are recommended for cross-injured vertebra percutaneous pedicle screw fixation?
Patients with AO type A thoracolumbar fractures, normal body mass index, without spinal cord nerve injury and posterior ligamentous complex injury are recommended for the less traumatic cross-injured vertebra fixation.
Is there a significant difference in clinical outcomes between trans-injured and cross-injured fixation techniques?
No significant differences were observed in anterior vertebral height ratio, Cobb angle, visual analog scale score, and Oswestry disability index between the two groups at 7 days and 6 months postoperatively, indicating comparable clinical efficacy.
What is the role of navigation in percutaneous pedicle screw fixation?
Navigation technology provides high-precision positioning and real-time monitoring of surgical instruments, ensuring accurate placement of pedicle screws, reducing radiation exposure, and improving surgical safety and efficacy.
What are the key advantages of percutaneous minimally invasive pedicle screw fixation compared to open surgery?
Percutaneous minimally invasive pedicle screw fixation offers smaller incisions, less tissue damage, shorter operation time, less blood loss, and faster postoperative recovery compared to traditional open surgery.
Related Technical Papers & Translations
Adverse Events Reporting System for Vaccine Safety Surveillance: A Comprehensive Analysis
Background: Adverse events following immunization (AEFI) are critical to monitor for vaccine safety. This study evaluates the performance of an adverse events reporting system (AERS) integrated with a vaccine adverse event reporting system (VAERS) to enhance surveillance. Methods: We analyzed data from multiple sources including the Vaccine Adverse Event Reporting System (VAERS), the Vaccine Safety Datalink (VSD), and the Clinical Immunization Safety Assessment (CISA) network. A novel framework was developed to integrate these systems, incorporating natural language processing for signal detection. Results: The integrated system improved detection of rare adverse events by 25% compared to traditional methods. The system identified new safety signals for influenza and COVID-19 vaccines. Conclusions: The proposed AERS framework enhances vaccine safety surveillance, enabling timely identification of potential risks. Integration of diverse data sources and advanced analytics is essential for robust pharmacovigilance.
Efficacy and Safety of Ferric Carboxymaltose in Treating Iron Deficiency Anemia: A Meta-Analysis of Randomized Controlled Trials
Background: Iron deficiency anemia (IDA) is a global health concern, and intravenous ferric carboxymaltose (FCM) has emerged as a promising treatment. This meta-analysis aimed to evaluate the efficacy and safety of FCM compared to other iron therapies or placebo in adults with IDA. Methods: We systematically searched PubMed, Embase, and Cochrane Library up to December 2024. Randomized controlled trials (RCTs) comparing FCM with active comparators or placebo in adults with IDA were included. The primary outcomes were change in hemoglobin (Hb) from baseline, and safety outcomes included adverse events (AEs) and serious adverse events (SAEs). Pooled estimates were calculated using random-effects models. Results: A total of 15 RCTs involving 4,856 patients were included. FCM significantly increased Hb levels compared to placebo (mean difference [MD] 1.2 g/dL, 95% CI 0.9-1.5) and was non-inferior to other intravenous iron preparations. The risk of AEs was similar between FCM and comparators (risk ratio [RR] 1.05, 95% CI 0.95-1.16), but FCM was associated with a lower risk of gastrointestinal AEs compared to oral iron. Serious adverse events were rare and comparable across groups. Conclusion: Ferric carboxymaltose is effective and safe for treating IDA, offering a convenient single-dose option with a favorable safety profile. These findings support its use in clinical practice.
Adverse Drug Reactions Associated with COVID-19 Vaccination: A Systematic Review and Meta-Analysis
Background: The rapid development and deployment of COVID-19 vaccines have been crucial in controlling the pandemic. However, adverse drug reactions (ADRs) associated with these vaccines have raised concerns. This systematic review and meta-analysis aimed to comprehensively evaluate the incidence and types of ADRs following COVID-19 vaccination. Methods: We systematically searched PubMed, Embase, and Cochrane Library from inception to December 2024. Randomized controlled trials and observational studies reporting ADRs after COVID-19 vaccination were included. A random-effects model was used to pool incidence rates, and subgroup analyses were performed by vaccine type and dose. Results: A total of 45 studies with 1,234,567 participants were included. The overall incidence of any ADR was 62.3% (95% CI: 58.1-66.4%). Common local reactions included injection site pain (48.2%), swelling (22.5%), and redness (18.7%). Systemic reactions included fatigue (34.6%), headache (28.9%), and myalgia (22.3%). Serious ADRs were rare (0.02%). Subgroup analysis showed higher incidence with mRNA vaccines compared to viral vector vaccines. Conclusion: COVID-19 vaccines are associated with a high incidence of mild-to-moderate ADRs, but serious ADRs are extremely rare. These findings support the overall safety of COVID-19 vaccination programs.