Perkutane dorsale Stabilisierung an der Brust- und Lendenwirbelsäule mit dem Expedium LIS

Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures compared with open technique

BACKGROUND

This study aimed to compare the accuracy of screw placement between open pedicle screw fixation and percutaneous pedicle screw fixation (MIS) for the treatment of thoracolumbar spine fractures (TSF).

METHODS

forty-nine patients with acute TSF who were treated with transpedicular screw fixation from January 2013 to December 2016 were retrospectively reviewed. The patients were divided into Open and MIS groups. Laminectomy was performed in either group if needed. The accuracy of the screw placement, the evolution of the Cobb sagittal angle postoperatively and at 12-month follow-up and the neurological status were recorded. AO type of fracture and TLICS score were also recorded.

RESULTS

Mean age was 42 years old. Mean TLICS score was 6.29 and 5.96 for open and MIS groups respectively. Twenty-five MIS and 24 open surgeries were performed, and 350 (175 in each group) screws were inserted (7.14 per patient). Twenty-four and 13 screws were considered "out" in the open and MIS groups respectively (Odds ratio 1.98. 0.97-4,03 P=0.056). The Cobb sagittal angle went from 13.3º to 4.5º and from 14.9º to 8.2º in the Open and MIS groups respectively (both P<0.0001). Loss of correction at 12-month follow-up was 3.2º and 4.2º for the open and MIS groups, respectively. No neurological worsening was observed.

CONCLUSIONS

For the treatment of acute thoracolumbar fractures, the MIS technique seems to achieve similar results to the open technique in relation to neurological improvement and deformity correction, while placing the screws more accurately.

Open Versus Minimally Invasive Fixation Techniques for Thoracolumbar Trauma: A Meta-Analysis

Study Design Systematic literature review and meta-analysis of studies published in English. Objective This study evaluated differences in outcome variables between percutaneous and open pedicle screws for traumatic thoracolumbar fractures. Methods A systematic review of PubMed, Cochrane, and Embase was performed. The variables of interest included postoperative visual analog scale (VAS) pain score, kyphosis angle, and vertebral body height, as well as intraoperative blood loss and operative time. The results were pooled by calculating the effect size based on the standardized difference in means. The studies were weighted by the inverse of the variance, which included both within- and between-study error. Confidence intervals were reported at 95%. Heterogeneity was assessed using the Q statistic and I (2). Results After two-reviewer assessment, 38 studies were eliminated. Six studies were found to meet inclusion criteria and were included in the meta-analysis. The combined effect size was found to be in favor of percutaneous fixation for blood loss and operative time (p < 0.05); however, there were no differences in vertebral body height (VBH), kyphosis angle, or VAS scores between open and percutaneous fixation. All of the studies demonstrated relative homogeneity, with I (2) < 25. Conclusions Patients with thoracolumbar fractures can be effectively managed with percutaneous or open pedicle screw placement. There are no differences in VBH, kyphosis angle, or VAS between the two groups. Blood loss and operative time were decreased in the percutaneous group, which may represent a potential benefit, particularly in the polytraumatized patient. All variables in this study demonstrated near-perfect homogeneity, and the effect is likely close to the true effect.

Update on the surgical management of Pott's disease

One-third of the world's population is infected with Mycobacterium tuberculosis. Data reported in 2011 indicate, for the first time, a decline in cases of tuberculosis, despite persistent inequalities across geographic areas and increasing rates of drug resistance. Osteo-articular tuberculosis affects the spine in half the cases. Pharmacotherapy must be combined with surgery in patients with spinal cord or nerve root compression, large abscesses, or marked anterior column osteolysis with kyphosis and instability. The quality of debridement and bony fusion is optimal when the anterior approach is used. Posterior fixation is the best means of achieving reduction followed by stable sagittal alignment over time. New treatment strategies combine conventional surgical methods, closed interventional radiology procedures for drainage and spinal cord decompression, and percutaneous fixation.

[Indications for deformity correction with minimally invasive spondylodesis]

The indications for surgical treatment of thoracic, lumbar, combined and thoracolumbar scoliosis are given for a curvature of the thoracic spine with a Cobb angle more than 50° and more than 45° in the lumbar spine. The maximum Cobb angle is 90°. The aim is the correction of more than 50% in the frontal plane and correction of scoliosis is possible in flexible curvatures up to 90%. By the minimally invasive surgical technique the muscular damage is completely avoided on the convex side but on the concave side this is only partly possible. This is the first report of a muscle preserving minimally invasive surgical technique for the convex side of scoliosis.