Introduction

Thoracolumbar fractures are among the most common spinal injuries, with burst fractures predominating at the thoracolumbar junction. The management of unstable burst and flexion-distraction injuries in patients without neurological deficit remains debated, with both operative and non-operative strategies in use. Non-operative management with bracing or recumbency can yield acceptable outcomes but has been associated with residual kyphosis, prolonged immobilization, and late neurological deterioration in a subset of patients [1].

The goals of treatment are to restore and maintain sagittal alignment and vertebral height, achieve fracture healing, and, where possible, preserve adjacent-segment motion [2]. Surgical stabilization provides more reliable restoration of alignment, vertebral height, and canal dimensions than conservative care, and posterior short-segment pedicle instrumentation is the most widely used construct worldwide [3-6].

However, the conventional open posterior approach requires extensive paraspinal exposure and is associated with significant blood loss, infection risk, and iatrogenic muscle denervation [5,6].

Percutaneous pedicle screw fixation (PPSF), introduced by Magerl and later refined for the lumbar spine, was developed to provide equivalent posterior stabilization while limiting soft-tissue trauma [7,8]. Compared with open fixation, PPSF has been associated with less paraspinal muscle damage, reduced blood loss, less postoperative pain, and a shorter hospital stay [9,10]. Its principal trade-offs include dependence on intraoperative imaging, with attendant radiation exposure, the absence of formal arthrodesis and decompression, and a recognized learning curve.

Most reported PPSF series originate from centers using biplanar imaging or navigation. Evidence from public tertiary centers using a single conventional C-arm is more limited. This study evaluated the perioperative profile, immediate radiographic correction, and pedicle screw placement accuracy of PPSF performed under single conventional fluoroscopy in neurologically intact patients with thoracolumbar fractures.

Aim and objectives

The aim of this study was to evaluate the efficacy and safety of PPSF for thoracolumbar fractures. The specific objectives were to assess (i) postoperative hospital stay, postoperative pain, kyphotic (Cobb) angle correction, and vertebral body height restoration; and (ii) pedicle screw placement accuracy, operative time, and intraoperative blood loss.