Abstract
BACKGROUND: The management of thoracolumbar burst fractures with retropulsion has been a matter of debate, the present study aimed to investigate the clinical and radiological outcomes of a transfacet pedicle-sparing approach for directly addressing the compression of unstable thoracolumbar burst fractures with retropulsion. METHODS: We examined a cohort of 163 consecutive patients diagnosed with unstable thoracolumbar burst fractures that exhibited significant canal compromise. These patients underwent a transfacet pedicle-sparing procedure aimed at directly alleviating the compression caused by the retropulsed bone segment at our institution. Clinical outcomes were assessed using the Frankel scale and the Oswestry Disability Index (ODI), while radiological outcomes were evaluated based on the Cobb angle, percentage of anterior height compression (PAHC), vertebral body compression rate (VBCR), and canal compromise. RESULTS: Among the 163 patients, 98 (59.8%) were male and 66 (40.2%) were female. The mean age of the participants was 45.42 ± 8.71 years, with an average follow-up period of 21.19 ± 4.42 months. Postoperative assessments revealed a significant reduction in canal compromise, decreasing to 9.72 ± 1.73 from a preoperative value of 61.21 ± 5.33 (p < 0.001). The Cobb angle also demonstrated a significant postoperative reduction (p = 0.011). Both VBCR and PAHC showed significant decreases postoperatively when compared to preoperative measurements (p < 0.05). Neurological outcomes improved significantly postoperatively, as indicated by the Frankel grade (p < 0.05). Furthermore, the ODI at the last follow-up was significantly lower than the preoperative ODI (p < 0.001), reflecting a marked enhancement in patient functionality. CONCLUSIONS: Our research has shown that the transfacet pedicle-sparing approach is an effective technique for directly managing the compression of unstable thoracolumbar burst fractures with retropulsion, resulting in favorable clinical and radiological outcomes. CLINICAL TRIAL NUMBER: Not applicable.