Efficacy and Safety of Percutaneous Pedicle Screw Fixation for Neurologically Intact Thoracolumbar Burst Fractures: A Prospective Interventional Study

Background: Open posterior short-segment pedicle instrumentation is an established treatment for unstable thoracolumbar fractures but carries approach-related morbidity from paraspinal muscle stripping. Percutaneous pedicle screw fixation (PPSF) aims to provide comparable stabilization with reduced soft-tissue trauma. We evaluated the perioperative profile, radiographic correction, and screw-placement accuracy of PPSF performed under single conventional fluoroscopy in neurologically intact patients. Methods: In this prospective, single-arm interventional study, 46 consecutive patients aged 18-50 years with AO Spine type A3/A4 thoracolumbar fractures and intact neurology (American Spinal Injury Association (ASIA) grade E) underwent short-segment PPSF over an 18-month period at a tertiary public hospital. Operative time, intraoperative blood loss, visual analog scale (VAS) pain score, length of hospital stay, sagittal Cobb angle, and anterior vertebral body height (AVBH) were recorded. Screw placement was graded on postoperative CT using the Gertzbein-Robbins classification. Preoperative and postoperative radiographic parameters were compared using paired analysis. Results: Mean age was 30.8±8.8 years; 28 patients (60.9%) were female. The most common mechanism of injury was a fall from height (65.2%), and the most commonly affected level was L2 (54.3%). Mean operative time was 108.2±12.1 minutes, and mean blood loss was 102.6±16.1 mL. Mean length of hospital stay was 2.6±0.7 days, and mean VAS score decreased from 4.4±0.6 (day 0) to 2.6±0.7 (day 3). Cobb angle improved from 18.9±5.9° to 8.7±5.9°, and AVBH improved from 55.3±11.0% to 74.3±10.4% (both p<0.01). Of 184 screws, 173 (94.0%) were Gertzbein-Robbins grade A, whereas 11 (6.0%) were malpositioned (grades B-D), with none causing neurovascular injury. There were no infections, implant failures, or screw revisions. Conclusion: PPSF is a safe and minimally invasive technique that demonstrated favorable immediate perioperative and radiographic outcomes, with high pedicle screw placement accuracy and no early procedure-related complications in selected neurologically intact patients with thoracolumbar fractures. Further prospective comparative studies with longer follow-up are required to establish its long-term clinical outcomes and comparative effectiveness.