Minimally invasive spine (MIS) surgery in traumatic thoracolumbar fractures: A single-center experience

 

 Permissions and Reprints

Objective: Traumatic thoracolumbar fractures are common, and surgical fixation is a well-established treatment option, with the aim to achieve spinal stability and preserve neurological function. Pedicle screw fixation using a minimally invasive spine (MIS) surgical approach has emerged as an alternative approach for the treatment of thoracolumbar fractures. The aim of this study is to collect data regarding epidemiology, management, and outcomes of patients treated with MIS pedicle screw fixation for traumatic thoracolumbar fractures in our neurosurgical department. Materials and Methods: This was a retrospective cohort study including all patients who underwent MIS fixation from March 2013 to March 2017. Results: A total of 125 patients were included, 61 males and 64 females; the mean age was 59 years. The majority of injuries were from falls. In 48 cases, the fracture involved a thoracic vertebra and in 77 cases a lumbar vertebra. More than 10% of the patients presented with a neurological deficit on admission and 75% of those showed postoperative improvement in their neurology. The average length of hospital stay was 14 days. MIS fixation achieved a satisfactory regional sagittal angle (RSA) postoperatively in all patients. The vast majority of patients had no or mild postoperative pain and achieved a good functional outcome. Conclusions: MIS fixation is a safe surgical option with comparable outcomes to open surgery and a potential reduction in perioperative morbidity. MIS surgery achieves a rapid and significant improvement in pain score, functional outcome, Frankel Grade, and RSA. We expect that MIS fixation will become the predominant technique in the management of traumatic thoracolumbar fractures.

Financial support and sponsorship

Nil.

Publication History

Received: 24 July 2019

Accepted: 23 December 2019

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

• References

• 1 Rampersaud YR, Annand N, Dekutoski MB. Use of minimally invasive surgical techniques in the management of thoracolumbar trauma: Current concepts. Spine (Phila Pa 1976) 2006;31:S96-102.
• 2 Gertzbein SD. Scoliosis research society. Multicenter spine fracture study. Spine (Phila Pa 1976) 1992;17:528-40.
• 3 Levine AM, McAfee PC, Anderson PA. Evaluation and emergent treatment of patients with thoracolumbar trauma. Instr Course Lect 1995;44:33-45.
• 4 Ge CM, Wang YR, Jiang SD, Jiang LS. Thoracolumbar burst fractures with a neurological deficit treated with posterior decompression and interlaminar fusion. Eur Spine. 2011;20: 2195-2201.
• 5 Meldon SW, Moettus LN. Thoracolumbar spine fractures: Clinical presentation and the effect of altered sensorium and major injury. J Trauma 1995;39:1110-4.
• 6 Bosch A, Stauffer ES, Nickel VL. Incomplete traumatic quadriplegia. A ten-year review. JAMA 1971;216:473-8.
• 7 Cooper C, Dunham CM, Rodriguez A. Falls and major injuries are risk factors for thoracolumbar fractures: Cognitive impairment and multi injuries impede the detection of back pain and tenderness. J Trauma 1995;38:692-6.
• 8 Riggins RS, Kraus JF. The risk of neurologic damage with fractures of the vertebra Title. J Trauma 1977;17:126-33.
• 9 Stover SL, Fine PR. The epidemiology and economics of spinal cord injury. Paraplegia 1987;25:225-8.
• 10 Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM. Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma 2001;15:566-9.
• 11 Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJ, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: A systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa 1976) 2004;29:803-14.
• 12 Siebenga J, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, Patka P. Spine fractures caused by horse riding. Eur Spine J 2006;15:465-71.
• 13 Dong SH, Chen HN, Tian JW, Xia T, Wang L, Zhao QH, et al. Effects of minimally invasive percutaneous and trans-spatium intermuscular short-segment pedicle instrumentation on thoracolumbar mono-segmental vertebral fractures without neurological compromise. Orthop Traumatol Surg Res 2013;99:405-11.
• 14 Lee JK, Jang JW, Kim TW, Kim TS, Kim SH, Moon SJ. Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures: Is it effective?: Comparative study with open short-segment pedicle screw fixation with posterolateral fusion. Acta Neurochir (Wien) 2013;155:2305-12.
• 15 Jiang XZ, Tian W, Liu B, Li Q, Zhang GL, Hu L, et al. Comparison of a paraspinal approach with a percutaneous approach in the treatment of thoracolumbar burst fractures with posterior ligamentous complex injury: A prospective randomized controlled trial. J Int Med Res 2012;40:1343-56.
• 16 Mobbs RJ, Sivabalan P, Li J. Technique, challenges and indications for percutaneous pedicle screw fixation. J Clin Neurosci 2011;18:741-9.
• 17 Hsieh PC, Koski TR, Sciubba DM, Moller DJ, O'Shaughnessy BA, Li KW, et al. Maximizing the potential of minimally invasive spine surgery in complex spinal disorders. Neurosurg Focus 2008;25:E19.
• 18 Beisse R. Endoscopic surgery on the thoracolumbar junction of the spine. Eur Spine J 2006;15:687-704.
• 19 Holly LT, Schwender JD, Rouben DP, Foley KT. Minimally invasive transforaminal lumbar interbody fusion: Indications, technique, and complications. Neurosurg Focus 2006;20:E6.
• 20 Kerr SM, Tannoury C, White AP, Hannallah D, Mendel RC, Anderson DG. The role of minimally invasive surgery in the lumbar spine. Oper Tech Orthop 2007;17:183-9.
• 21 Oppenheimer JH, DeCastro I, McDonnell DE. Minimally invasive spine technology and minimally invasive spine surgery: A historical review. Neurosurg Focus 2009;27:E9.
• 22 Esses SI, Botsford DJ, Kostuik JP. Evaluation of surgical treatment for burst fractures. Spine (Phila Pa 1976) 1990;15:667-73.
• 23 Park Y, Ha JW, Lee YT, Sung NY. Cranial facet joint violations by percutaneously placed pedicle screws adjacent to a minimally invasive lumbar spinal fusion. Spine J 2011;11:295-302.
• 24 Patel RD, Graziano GP, Vanderhave KL, Patel AA, Gerling MC. Facet violation with the placement of percutaneous pedicle screws. Spine (Phila Pa 1976) 2011;36:E1749-52.
• 25 Knox JB, Dai JM 3rd, Orchowski JR. Superior segment facet joint violation and cortical violation after minimally invasive pedicle screw placement. Spine J 2011;11:213-7.
• 26 Tsuang FY, Chen CH, Kuo YJ, Tseng WL, Chen YS, Lin CJ, et al. Percutaneous pedicle screw placement under single dimensional fluoroscopy with a designed pedicle finder-a technical note and case series. Spine J 2017;17:1373-80.
• 27 Kraus M, Weiskopf J, Dreyhaupt J, Krischak G, Gebhard F. Computer-aided surgery does not increase the accuracy of dorsal pedicle screw placement in the thoracic and lumbar spine: A retrospective analysis of 2,003 pedicle screws in a level I trauma center. Global Spine J 2015;5:93-101.
• 28 McAnany SJ, Overley SC, Kim JS, Baird EO, Qureshi SA, Anderson PA. Open versus minimally invasive fixation techniques for thoracolumbar trauma: A meta-analysis. Global Spine J 2016;6:186-94.