Clinical effect of percutaneous endoscopic visual trephine decompression combined with pedicle screw fixation in the treatment of lumbar vertebral burst fracture with secondary spinal canal stenosis

PURPOSE: To evaluate the feasibility and preliminary clinical outcomes of percutaneous endoscopic visual trephine decompression (PEVTD) in combination with pedicle screw fixation for the treatment of lumbar burst fractures with secondary spinal stenosis. METHODS: A retrospective analysis was conducted on 21 patients with lumbar burst fractures and secondary spinal stenosis treated from December 2022 to December 2024. All patients underwent PEVTD combined with percutaneous pedicle screw internal fixation. The duration of endoscopic decompression surgery, blood loss, the incidence of intraoperative dural tearing, the Visual Analogue Scale (VAS) for pain score, the American Spinal Injury Association (ASIA) grade, and the MRI dural sac cross-sectional area were recorded to assess the effectiveness of decompression. RESULTS: The mean operative time for endoscopic decompression was 49.3 ± 10.2 min (41-60 min) with an estimated blood loss of approximately 160 ml. No intraoperative dural tearing occurred. Compared with the preoperative values, the postoperative VAS score and ASIA grade at 1 week and 1 year significantly improved(P < 0.05). The dural sac cross-sectional area increased significantly postoperatively (P < 0.01). CONCLUSION: PEVTD appears to be a feasible minimally invasive technique for treating lumbar burst fractures with secondary spinal canal stenosis in selected patients (those without posterior column injury and with ≤ 50% canal compromise). The preliminary results suggest that PEVTD is a feasible minimally invasive technique with short-term outcomes that appear acceptable in this selected cohort, although these findings are exploratory and require confirmation in prospective comparative studies.