A comparative analysis of three distinct approaches for the management of type A1 traumatic thoracolumbar fractures: a retrospective cohort study with a minimum 6-year follow-up.

Objective: Comparing the efficacy of conservative treatment, percutaneous pedicle screw fixation and percutaneous balloon kyphoplasty with calcium sulphate particles in the treatment of AO Spine type A1 traumatic thoracolumbar fractures.

Methods: The 220 patients with type A1 thoracolumbar fractures were divided into group A (n = 63, conservative treatment), group B (n = 85, percutaneous pedicle screw fixation), and group C (n = 72, percutaneous balloon kyphoplasty with calcium sulphate particle). Before treatment, 1 months and 2 years after treatment, and at the final follow-up, the efficacy was measured and compared between the three groups. Calcium sulphate particles ossification was assessed in patients from group C at 9 and 12 months postoperatively using computed tomography scans.

Results: At the corresponding time points, the anterior vertebral body height ratio and Cobb angle were significantly better in groups B and C than in group A (all P < 0.05). At 1-month follow-up, visual analogue scale and oswestry disability index scores were significantly lower in groups B and C than in group A (P < 0.05), but the difference was not significant between the three groups at the subsequent follow-up (P > 0.05). Group C had significantly shorter operation time, less intraoperative blood loss, and shorter incision length compared to group B (all P < 0.05). At 12 months after surgery, computed tomography scan showed that the calcium sulphate particle disappeared and was replaced by autologous newly formed bone in patients of group C.

Conclusion: For the management of type A1 thoracolumbar fractures, all three treatment methods demonstrated satisfactory clinical efficacy. After interim follow-up, similar levels of pain relief and functional improvement were observed across the three methods. Both percutaneous pedicle screw fixation and kyphoplasty with calcium sulphate particle exhibited similar efficacy in correcting kyphotic Cobb angle and restoring vertebral body height, with both being superior to conservative treatment. Notably, percutaneous balloon kyphoplasty with calcium sulphate particle exhibited a more minimally invasive profile compared with percutaneous pedicle screw fixation.