Comparative Radiologic and Morphologic Analysis of Posterolateral Fusion and Percutaneous Pedicle Screw Fixation for Thoracolumbar Junction Burst Fractures

<b>Background/Objectives:</b> Thoracolumbar burst fractures often require surgical stabilization. Although posterolateral fusion (PLF) has been traditionally used, percutaneous posterior fixation (PPF) without fusion has emerged as a less invasive alternative. However, comparative data specifically addressing PPF and PLF are limited. This study aimed to compare the radiological and perioperative outcomes of PPF and PLF for thoracolumbar burst fractures. <b>Methods:</b> This retrospective cohort study analyzed 61 patients with T11-L2 burst fractures (PPF, 28; PLF, 33). Radiological parameters included local and global sagittal alignment and vertebral height ratio. Fracture morphology was assessed using a structured grading system based on anterior height ratios. Perioperative variables were also assessed. Statistical significance was set at <i>p</i> < 0.05. <b>Results:</b> PPF demonstrated significant advantages in operative time (160.7 min vs. 205.8 min, <i>p</i> < 0.01) and blood loss (165 cc vs. 317 cc, <i>p</i> < 0.01), with a shorter hospitalization time. PPF achieved outcomes comparable to PLF in global alignment and anterior height restoration. The PLF group showed greater local kyphotic angle correction (-7.77° vs. -1.53°, <i>p</i> = 0.01), whereas the PPF group showed significantly higher postoperative posterior height ratio (<i>p</i> = 0.02). Changes in morphological grades, assessed using the anterior height ratio-based grading system, showed similar patterns of improvement in both groups. All implant removals were performed due to patient-reported discomfort. <b>Conclusions:</b> PPF yielded radiological outcomes comparable to PLF in the treatment of thoracolumbar burst fractures. The use of a morphological grading system provided a structured descriptive tool to evaluate surgical impact, though its utility remains exploratory and requires further validation.