Minimally invasive spine surgery in acute dorsolumbar trauma: An experience of 14 cases

Abstract

This study evaluates the effectiveness of minimally invasive treatment of dorso-lumbar fractures by percutaneous pedicle screw fixation. Patients of acute traumatic single level dorsolumbar and spine fractures requiring surgical intervention were included in this study. Fourteen patients (10 male, 4 female), age range 17–47 years (mean 30.1 ± 7.9 yrs) with dorso-lumbar fractures (D9:1, D12:3, L1:9, L4:1) with TLICS score>4 were studied (Feb 2009–Feb 2011). Total of 60 screws were put of which 2 screws were malpositioned (3.3%). Open conversion was done in two cases (15.3%) due to difficulty in rod positioning. In one case, screw pull out was noted intraoperatively during ligamentotaxis and rod manipulation. No patient had post-operative neurological deterioration. Mean post-operative hospital stay was 3.8 days. Follow-up scans showed satisfactory correction of deformity. Good to excellent outcome was present in 84.6%. We conclude that percutaneous pedicle screws fixation is a safe, reliable, cost effective technique with favorable results in acute polytrauma cases requiring standalone ligamentotaxis. Complex biomechanics/physics of instrumentation, lack of adequate fusion and steep learning curve during initial cases with increased radiation exposure limits its application in all cases.

Keywords

dorsolumbar fractures - minimally invasive - pedicle screws - percutaneous

• References

• 1 Gaines RW. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am 2000; 82-A: 1458-1476
• 2 Yuan HA, Garfin SR, Dickman CA. et al A historical cohort study of pedicle screw fixation in thoracic, lumbar, and sacral spine fusions. Spine 1994; 19 (Suppl. 20) 2279S-2296S
• 3 Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res 1984; 189: 125-141
• 4 Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg 2002; 97: 7-12
• 5 Vaccaro AR, Lehman Jr RA, Hurlbert RJ. et al A new classification of thoracolumbar injuries: The importance of injury morphology, the integrity of posterior ligamentous complex, and neurologic status. Spine 2005; 30: 2325-2333
• 6 American Spinal Injury Association. International standards for neurological classification of spinal cord injuries, revised 2000. 6^th ed American Spinal Injury Association; Chicago, IL: 2000
• 7 Grützner PA, Beutler T, Wendl K. et al Navigation an der Brust-und Lendenwirbelsäule mit dem 3D-Bildwandler. Chirurg 2004; 75: 967-975
• 8 Zdeblick TA. A prospective, randomized study of lumbar fusion. Preliminary results. Spine 1993; 18: 983-991
• 9 Siebenga J, Leverink VJ, Segers MJ. et al Treatment of traumatic thoraco-lumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine 2006; 31: 2881-2890
• 10 Gelb D, Ludwig S, Karp JE. et al Successful treatment of of thoraco-lumbar fracture with short- segment pedicle instrumentation. J Spinal Disord Tech 2010; 23: 293-301
• 11 Knop C, Kranabetter T, Reinhold M, Blauth M. Combined postero-anterior stabilization of thoraco-lumbar injuries utilizing a vertebral body replacing implant. Eur Spin J 2009; 18: 949-963
• 12 Wiesner L, Kothe R, Schulitz KP. et al Clinical evaluation and computerized tomography scan analysis of screw tracts after percutaneous insertion of pedicle screws in lumbar spine. Spine 2000; 25: 615-621
• 13 Schwender JD, Holly LT, Rouben DP, Foley KT. Minimally invasive transforaminal lumbar interbody fusion (TLIF); technical feasibility and initial results. J Spinal Disord Tech 2005; 18 suppl S1-S6
• 14 Fassett DR, Brodke DS. Percutaneous lumbar pedicle screws. Vaccaro AR, Bono CM. (Eds) Minimally invasive spine surgery. Informa healthcare; New York: 2007: 229-235
• 15 Haid Jr KW, Subach BR, Rodts Jr GE. Advances in spinal stabilization. Prog Neurol Surg 2003; 16: 204-212