Conclusions

PPSF is a safe, effective, and minimally invasive treatment option for neurologically intact patients with thoracolumbar vertebral fractures. In this prospective study of 46 patients, the technique was associated with low intraoperative blood loss, acceptable operative time, reduced postoperative pain, a short hospital stay, significant correction of kyphotic deformity, and restoration of AVBH. Furthermore, postoperative CT evaluation demonstrated high pedicle screw placement accuracy, with no neurovascular complications related to screw malposition, confirming the safety of the procedure.

The present study supports the immediate technical safety and favorable perioperative outcomes of PPSF in selected AO type A3 and A4 thoracolumbar fractures without neurological deficit. By minimizing soft-tissue injury while providing reliable spinal stabilization and satisfactory radiologic outcomes, this technique facilitates early postoperative recovery and may reduce approach-related morbidity. However, no conclusions can be drawn regarding the long-term maintenance of deformity correction, implant longevity, functional recovery, or late complications. The absence of a comparison group precludes assessment of comparative effectiveness. Nevertheless, larger prospective comparative studies with longer follow-up are required to evaluate the long-term clinical efficacy, durability of deformity correction, implant-related complications, the need for implant removal, and the comparative effectiveness of PPSF.