Efficacy of paraspinal muscle-sparing approach in the treatment of thoracolumbar burst fractures with neurological deficits

Abstract

Objective: To evaluate the clinical efficacy of pedicle screw fixation via a paraspinal muscle-sparing approach in the surgical treatment of thoracolumbar burst fractures (TCBFs) complicated by neurological deficits.

Methodology: A total of 90 patients with TCBFs and associated neurological deficits, treated at The Affiliated Hospital of Bei-hua University between January 2024 to January 2025, were retrospectively analyzed. These patients were divided into three groups by the choice of surgical approach, namely a posterior midline approach (PMA) group, paraspinal muscle-sparing approach (PMSA) group and minimally invasive percutaneous approach (MIPA) group. Perioperative parameters, postoperative recovery, pre- and post-operative Cobb angles and anterior vertebral body height of the fractured segments were compared among the three groups.

Results: All surgical incisions healed primarily without infection and no cases of implant failure, including breakage, loosening, or migration, were observed during the one-year follow-up. Significant differences were found among the three groups in duration of operation (DoO), intraoperative blood loss (IBL), postoperative drainage volume (PDV) and length of hospital stay (LoHS) (all P < 0.05). The PMSA group had the shortest DoO, while the PMA group had the longest. The MIPA group exhibited the least IBL and PDV, whereas the PMA group had the most. Both the PMSA and MIPA groups had shorter LoHS compared with the PMA group. Postoperative improvements in the Cobb angle and relative anterior height of the fractured vertebra were significant within each group, but no statistically significant differences were observed among the three groups (all P > 0.05). Visual Analog Scale (VAS) scores significantly decreased over time in all groups, while Activities of Daily Living (ADL) and Japanese Orthopaedic Association (JOA) scores progressively increased, with within-group differences at different time points reaching statistical significance (all P < 0.05). However, no statistically significant intergroup differences were observed in VAS, ADL, or JOA scores at corresponding time points (all P > 0.05). The rates of excellent and good outcomes based on the modified MacNab criteria were 90.00%, 86.67% and 80.00% in the PMSA, PMA and MIPA groups, respectively, with no statistically significant difference among the three groups (P > 0.05).

Conclusion: Pedicle screw fixation via a paraspinal muscle-sparing approach is a safe and effective treatment for TCBFs with neurological deficits. This technique can facilitate radiographic correction and promote postoperative neurological recovery while minimizing surgical trauma.