nach oben

Erschienen in:

08.12.2016 | Original Article

How safe is minimally invasive pedicle screw placement for treatment of thoracolumbar spine fractures?

verfasst von: Timo Michael Heintel, Stefan Dannigkeit, Annabel Fenwick, Martin Cornelius Jordan, Hendrik Jansen, Fabian Gilbert, Rainer Meffert

Erschienen in: European Spine Journal | Ausgabe 5/2017

Einloggen, um Zugang zu erhalten

Abstract

Study design

Prospective analysis of patients who underwent minimally invasive posterior instrumentation.

Objective

The purpose of this study was to evaluate the safety of minimally invasive pedicle screw placement in patients with unstable thoracic and lumbar spine fractures using the conventional fluoroscopy technique.

Summary of background data

Although wound infection, haematoma, and new neurological deficit due to screw malplacement remain a common source of morbidity, estimates of their rates of occurrence remain relatively limited.

Methods

2052 percutaneous pedicle screws in 433 consecutive patients were evaluated. The accuracy of pedicle screw placement was based on evaluation of axial 3-mm slice computed tomography scans. Morbidity and mortality data were collected prospectively.

Results

A total of 2029 of 2052 screws (99%) had a good or excellent position. 5 screws (0.2%) showed a higher grade violation of the medial pedicle wall. Seven patients (1.8%) needed revision due to screw malposition (3 pat.), surgical site infection, postoperative haematoma, implant failure (2 pat.), and technical difficulties.

Conclusions

Minimally invasive transpedicular instrumentation is an accurate, reliable, and safe procedure to treat thoracic and lumbar spine fractures.

Alpantaki K, Bano A, Pasku D, Mavrogenis AF, Papagelopoulos PJ, Sapkas GS, Korres DS, Katonis P (2010) Thoracolumbar burst fractures: a systematic review of management. Orthopedics 33(6):422–429CrossRefPubMed

Oner FC, Wood KB, Smith JS, Shaffrey CI (2010) Therapeutic decision making in thoracolumbar spine trauma. Spine 35:S235–S244CrossRefPubMed

Foley KT, Gupta SK, Justis JR, Sherman MC (2001) Percutaneous pedicle screw fixation of the lumbar spine. Neurosurg Focus 10:E10CrossRefPubMed

Reinhold M, Knop C, Beisse R, Audige L, Kandziora F, Pizanis A, Pranzl R, Gercek E, Schultheiss M, Weckbach A, Bühren V, Blauth M (2010) Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J 19:1657–1676CrossRefPubMedPubMedCentral

Khare S, Sharma V (2013) Surgical outcome of posterior short segment trans-pedicle screw fixation for thoracolumbar fractures. J Orthop 10(4):162–167CrossRefPubMedPubMedCentral

Mobbs RJ, Sivabalan P, Li J (2011) Technique, challenges and indications for percutaneous pedicle screw fixation. J Clin Neurosci 18(6):741–749CrossRefPubMed

Lee SH, Choi WG, Lim SR, Kang HY, Shin SW (2004) Minimally invasive anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis. Spine J 4:644–649CrossRefPubMed

Rahman M, Summers LE, Richter B, Mimran RI, Jacob RP (2008) Comparison of techniques for decompressive lumbar laminectomy: the minimally invasive versus the “classic” open approach. Minim Invasive Neurosurg 51:100–105CrossRefPubMed

Powers CJ, Isaacs RE (2006) Minimally invasive fusion and fixation techniques. Neurosurg Clin N Am 17:477–489CrossRefPubMed

10.

Dickerman RD, Reynolds AS, Tackett J, Winters K, Alvarado C (2008) Percutaneous pedicle screws significantly decrease muscle damage and operative time: surgical technique makes a difference. Eur Spine J 17:1398CrossRefPubMedPubMedCentral

11.

Wild MH, Glees M, Plieschnegger C, Wenda K (2007) Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures: a comparison of minimally invasive percutaneously and conventionally open treated patients. Arch Orthop Trauma Surg 127(5):335–343CrossRefPubMed

12.

Merom L, Raz N, Hamud C, Weisz I, Hanani A (2009) Minimally invasive burst fracture fixation in the thoracolumbar region. Orthopedics 32(4):273–275CrossRef

13.

Heintel TM, Berglehner A, Meffert R (2013) Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: a prospective trial. Eur Spine J 22(3):495–502CrossRefPubMed

14.

Zdichavsky M, Blauth M, Knop C, Graessner M, Herrmann H, Krettek C, Bastian L (2004) Accuracy of pedicle screw placement in thoracic spine fractures. Part I: inter- and intra-observer reliability of the scoring system. Eur J Trauma 30:234–240CrossRef

15.

Vaccaro AR, Schroeder GD, Kepler CK, Cumhur Oner F, Vialle LR, Kandziora F, Koerner JD, Kurd MF, Reinhold M, Schnake KJ, Chapman J, Aarabi B, Fehlings MG, Dvorak MF (2016) The surgical algorithm for the AOSpine thoracolumbar spine injury classification system. Eur Spine J 25(4):1087–1094CrossRefPubMed

16.

Lund T, Laine T, Österman H, Yrjönen T, Schlenzka D (2012) Accuracy of computer assisted screw insertion. The evidence. J Bone Joint Surg Br 94-B(SUPP XXXI):32

17.

Austin MS, Vaccaro AR, Brislin B, Nachwalter R, Hilibrand AS, Albert TJ (2002) Image-guided spine surgery; a cadaver study comparing conventional open laminoforaminotomy and two image-guided techniques for pedicle screw placement in posterolateral fusion and nonfusion models. Spine 27:2503–2508CrossRefPubMed

18.

Özkan N, Sandalcioglu IE, Petr O, Kurniawan A, Dammann P, Schlamann M, Sure U, Asgari S (2012) Minimally invasive transpedicular dorsal stabilization of the thoracolumbar and lumbar spine using the minimal access non-traumatic insertion system (MANTIS): preliminary clinical results in 52 patients. J Neurol Surg A Cent Eur Neurosurg 73(6):369–376CrossRefPubMed

19.

Hicks JM, Singla A, Shen FH, Arlet V (2010) Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine 35(11):E465–E470CrossRefPubMed

20.

Fehlings MG, Brodke DS, Norvell DC, Dettori JR (2010) The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference? Spine 35(9 Suppl):S37–S46PubMed

21.

Lall RR, Lall RR, Hauptman JS, Munoz C, Cybulski GR, Koski T, Ganju A, Fessler RG, Smith ZA (2012) Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist. Neurosurg Focus 33(5):E10CrossRefPubMed

22.

Gavaret M, Jouve JL, Péréon Y, Accadbled F, André-Obadia N, Azabou E, Blondel B, Bollini G, Delécrin J, Farcy JP, Fournet-Fayard J, Garin C, Henry P, Manel V, Mutschler V, Perrin G, Sales de Gauzy J, French Society of Spine Surgery SFCR (2013) Intraoperative neurophysiologic monitoring in spine surgery. Developments and state of the art in France in 2011. Orthop Traumatol Surg Res 99(6 Suppl):S319–S327CrossRefPubMed

23.

Hamilton DK, Smith JS, Sansur CA, Glassman SD, Ames CP, Berven SH, Polly DW Jr, Perra JH, Knapp DR, Boachie-Adjei O, McCarthy RE, Shaffrey CI, Scoliosis Research Society Morbidity and Mortality Committee (2011) Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee. Spine 36(15):1218–1228CrossRefPubMed

24.

Abbey DM, Turner DM, Warson JS, Wirt TC, Scalley RD (1995) Treatment of postoperative wound infections following spinal fusion with instrumentation. J Spinal Disord 8:278–283CrossRefPubMed

25.

Hodges SD, Humphreys SC, Eck JC, Covington LA, Kurzynske NG (1998) Low postoperative infection rates with instrumented lumbar fusion. South Med J 91:1132–1136CrossRefPubMed

26.

Picada R, Winter RB, Lonstein JE, Denis F, Pinto MR, Smith MD, Perra JH (2000) Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management. J Spinal Disord 13:42–45CrossRefPubMed

27.

Tenney JH, Vlahov D, Salcman M, Ducker TB (1985) Wide variation in risk of wound infection following clean neurosurgery. Implications for perioperative antibiotic prophylaxis. J Neurosurg 62:243–247CrossRefPubMed

28.

Weinstein MA, McCabe JP, Cammisa FP Jr (2000) Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13:422–426CrossRefPubMed

29.

Wimmer C, Gluch H, Franzreb M, Ogon M (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11:124–128PubMed

30.

O’Toole JE, Eichholz KM, Fessler RG (2009) Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine 11(4):471–476CrossRefPubMed

31.

Ni WF, Huang YX, Chi YL, Xu HZ, Lin Y, Wang XY, Huang QS, Mao FM (2010) Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. J Spinal Disord Tech 23(8):530–537CrossRefPubMed

32.

Blondel B, Fuentes S, Pech-Gourg G, Adetchessi T, Tropiano P, Dufour H (2011) Percutaneous management of thoracolumbar burst fractures: evolution of techniques and strategy. Orthop Traumatol Surg Res 97(5):527–532CrossRefPubMed

33.

Bironneau A, Bouquet C, Millet-Barbe B, Leclercq N, Pries P, Gayet LE (2011) Percutaneous internal fixation combined with kyphoplasty for neurologically intact thoracolumbar fractures: a prospective cohort study of 24 patients with one year of follow-up. Orthop Traumatol Surg Res 97(4):389–395CrossRefPubMed

34.

Smith JS, Shaffrey CI, Sansur CA, Berven SH, Fu KM, Broadstone PA, Choma TJ, Goytan MJ, Noordeen HH, Knapp DR Jr, Hart RA, Donaldson WF 3rd, Polly DW Jr, Perra JH, Boachie-Adjei O, Scoliosis Research Society Morbidity and Mortality Committee (2011) Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine 36(7):556–563CrossRefPubMed

Titel: How safe is minimally invasive pedicle screw placement for treatment of thoracolumbar spine fractures?
verfasst von: Timo Michael Heintel
Stefan Dannigkeit
Annabel Fenwick
Martin Cornelius Jordan
Hendrik Jansen
Fabian Gilbert
Rainer Meffert
Publikationsdatum: 08.12.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 5/2017
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4908-3

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

25.04.2024 | Hypertonie | Nachrichten

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

How safe is minimally invasive pedicle screw placement for treatment of thoracolumbar spine fractures?

Abstract

Study design

Objective

Summary of background data

Methods

Results

Conclusions

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Update Orthopädie und Unfallchirurgie

Springer Medizin

Abstract

Study design

Objective

Summary of background data

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2017

Posterior implant removal in patients with thoracolumbar spine fractures: long-term results

Reliability and reproducibility analysis of the AOSpine thoracolumbar spine injury classification system by Chinese spinal surgeons

Wire cerclage can restore the stability of the thoracic spine after median sternotomy: an in vitro study with entire rib cage specimens

The value of CT and MRI in the classification and surgical decision-making among spine surgeons in thoracolumbar spinal injuries

Announcements for issue 5, 2017

Measurement of kyphosis and vertebral body height loss in traumatic spine fractures: an international study

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Update Orthopädie und Unfallchirurgie