Comparison of stability of percutaneous minimally invasive pedicle screw insertion in thoracolumbar fractures through and across the injured vertebra under navigation

• 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.