Clinical and radiological outcomes of polymethyl methacrylate vertebroplasty versus posterior spinal fixation in thoracolumbar burst fracture: a randomized clinical trial

Management of thoracolumbar burst fracture patients with no neurological deficit is still a controversial issue. Vertebroplasty, as a minimally invasive technique, can be used as an alternative to open surgical procedures to avoid major complications. This study aims to compare the radiological and clinical outcomes of standalone polymethyl methacrylate (PMMA) vertebroplasty (VP), as a relatively safe, feasible, and uncomplicated procedure, to those of short-segment posterior spinal fixation (POSF). A prospective, single-blind, randomized clinical trial was conducted between April 2021 and May 2022. The patients were randomly devoted to group Ι or PMMA vertebroplasty (n=25), and group ΙΙ or POSF (n=25). The vertebral height reduction and kyphotic deformity as well as visual analog scale (VAS) and Oswestry Disability Index (ODI) were assessed to determine the radiological and clinical results, respectively.  The vertebral height reduction, kyphotic deformity, VAS, and ODI were decreased significantly compared to preoperative treatment in both groups. There was a significant reduction in group Ι in comparison to group ΙI in kyphotic deformity (5.16 vs. 8.45, P = 0.04, respectively) and vertebral height reduction (8.78 vs. 13.47, P = 0.01, respectively), especially after 12 months. Moreover, the VAS and ODI scores were significantly reduced in VP group than POSF group (2.16 vs. 4.51 and 10.36 vs. 16.10, respectively), 12 months postoperatively.  Due to the lack of neurological deficit, vertebroplasty with fewer intraoperative complications, low incidence of side effects, immediate spinal stability, and better postoperative pain control can be considered as an alternative for thoracolumbar burst fractures.