Is Open Decompression Required in Thoracolumbar Spinal Trauma?

Objective: This study aimed to evaluate the role of intraoperative computed tomography (CT) in optimizing both the surgical approach and outcomes during computer-assisted percutaneous ligamentotaxis using posterior spinal instrumentation for thoracolumbar injuries, specifically those involving posterior vertebral surface dislocation into the spinal canal.Methods: A retrospective analysis was conducted on patients who underwent surgery between January 2022 and January 2025. The primary outcomes assessed included canal widening, restoration of vertebral body height, and correction of kyphosis. Effectiveness outcomes were measured independently by 3 raters. Surgery-related complications and secondary quality-of-life measures, namely the Oswestry Disability Index (ODI) and visual analogue scale (VAS), were also evaluated. Additionally, the duration of surgical procedures was reviewed.Results: A total of 10 patients were included in the study. Preoperative and postoperative measurements for spinal canal compression, vertebral unit height, and kyphosis angle were 44%±15% (median [interquartile range], 43 [36–46]) versus 22%±11% (22 [14–27]); 18.5±4.1 mm (18 [15.5–20.2] mm) versus 31.9±3.5 mm (31 [29.5–34] mm); and 13.5°±2.4° (13.5° [11.5°–15.5°]) versus 8°±2.5° (8° [6°–10°]), respectively, with all differences reaching statistical significance (p<0.001). Postoperative VAS scores showed a decrease, with p=0.051. No major complications were observed. Open laminectomy for decompression was not required, as effective reduction of the retropulsed fragment was achieved in all cases. Furthermore, both operative times and hospital stays were shorter in cases where intraoperative CT was utilized.Conclusion: Indirect decompression techniques effectively reduce retropulsed fragments and lead to improvement in both spinal canal compression and kyphotic angle. The use of intraoperative CT allows open decompression to be safely performed or avoided, as appropriate, based on intraoperative findings.