Minimally Invasive Percutaneous Pedicle Screw Fixation in Thoracolumbar Spine Fractures: A Clinical Evaluation Study and Computed Tomography Scan Analysis of Screw Tracts.

Background and objective Thoracolumbar spine fractures represent significant traumatic injuries with substantial morbidity potential, necessitating surgical interventions that balance stability with minimal tissue disruption. Conventional open approaches, while providing excellent visualization, are associated with considerable muscle damage, blood loss, and prolonged recovery periods. Minimally invasive percutaneous pedicle screw fixation (MIPPSF) has emerged as a promising alternative that theoretically reduces surgical trauma while maintaining effective stabilization. This prospective interventional study aimed to evaluate the functional outcomes of MIPPSF among patients with thoracolumbar spine fractures and analyze screw tract placement accuracy using computed tomography scanning in carefully selected patients without neurological deficits. Methodology This prospective interventional study was conducted from May 2023 to October 2024 at R.L. Jalappa Hospital and Research Centre, Tamaka, India. Thirty patients presenting with thoracolumbar spine fractures requiring dorsal instrumentation were enrolled. Inclusion criteria encompassed patients >18 years with thoracic or lumbar spine fractures secondary to trauma, spinal neoplasia, or degenerative disorders without neurological deficits. Exclusion criteria comprised retropulsion segments occupying >50% of the spinal canal, previous spine surgery at the same level, significant posttraumatic segmental kyphosis ≥10°, and fracture dislocations. Functional outcomes were systematically assessed using validated instruments: Visual Analog Scale (VAS), Straight Leg Raise Test (SLRT), Modified Oswestry Disability Index (MODI), Core Outcome Measures Index (COMI), and Roland-Morris Questionnaire (RMQ). Assessments were performed preoperatively and at postoperative intervals of one, three, and six months. Radiological evaluation included postoperative CT scan analysis to identify screw tracts and potential pedicle breaches. Results Anatomical distribution revealed predominance at the L1-L2 intervertebral region (n= 18, 60.0%). All functional parameters demonstrated statistically significant improvement across successive timepoints (p<0.001). VAS pain scores decreased progressively from baseline (mean=7.83, SD=0.69) to six months postoperatively (mean=1.77, SD=0.43), representing a 77.4% reduction. SLRT improved from baseline (mean=49.67°, SD=8.08) to six months (mean=75.67°, SD=7.73), indicating 52.3% functional enhancement. MODI scores demonstrated a substantial reduction from baseline (mean=75.47, SD=7.06) to six months (mean=5.60, SD=1.99), reflecting a 92.6% decrease in disability. COMI scores improved from baseline (mean=6.35, SD=1.17) to six months (mean=1.98, SD=0.75), showing 68.8% improvement. RMQ scores decreased from baseline (mean=20.20, SD=1.95) to six months (mean=3.53, SD=1.71), representing an 82.5% reduction. Radiological assessment revealed exceptional accuracy, with only one patient (3.3%) exhibiting lateral pedicle breach, resulting in a 96.7% accuracy rate. Conclusion MIPPSF demonstrates excellent clinical and radiological outcomes in carefully selected patients with thoracolumbar fractures. Progressive functional improvement across all parameters, coupled with high screw placement accuracy, supports MIPPSF as an effective therapeutic option, achieving significant pain reduction and functional recovery while maintaining technical precision.