Minimally Invasive Spine (MIS) Surgery in Traumatic Thoracolumbar Fractures: A Single-Center Experience

Outcome of percutaneous pedicle screw fixation for traumatic thoracic and lumbar fractures -six years experience

OBJECTIVES

This study discusses the experience at our centre with treating traumatic thoracolumbar fractures using percutaneous pedicle screw fixation.

METHODS

We reviewed the case notes and imaging retrospectively between January 2013 and June 2019.

RESULTS

A total of 257 patients were included, 123 males and 134 females aged between 17 and 70; the mean age was 47.6 years. The majority of injuries were from fall from significant height. The fractures involved the thoracic and lumbar vertebra in 98 and 151 of the cases respectively. Percutaneous pedicle screw fixation was performed either one or two levels above and below the fracture depending on the level of injury. Forty two cases were treated with additional short pedicle screws at the level of fracture. More than 15% (39) of the patients presented with a neurological deficit; more than 80% (32) of those showed post-operative improvement in their neurology as per Frankel Grading system. The mean operative time was 117 min ± 45 min; mean length of hospital stay was 7.2 days ± 3.8 days, with significant improvement in pain.

CONCLUSIONS

Percutaneous pedicle screw fixation is a safe surgical option with comparable outcomes to open surgery and a potential reduction in perioperative morbidity.

Hidden blood loss and its influencing factors after minimally invasive percutaneous transpedicular screw fixation in thoracolumbar fracture

Background

Minimally invasive percutaneous transpedicular screw fixation (MIPTSF) is generally accepted as a minimally invasive treatment for thoracolumbar fracture. However, hidden blood loss (HBL) caused by this procedure is usually disregarded. This study aimed to investigate the amount of HBL and its influencing factors after MIPTSF in thoracolumbar fracture.

Methods

Between October 2017 and December 2020, a total of 146 patients (106 males and 40 females, age range 21–59 years) were retrospectively examined, and their clinical and radiological data were recorded and analyzed. The Pearson or Spearman correlation analysis was used to investigate an association between patient’s characteristics and HBL. Multivariate linear regression analysis was performed to elucidate the related clinical or radiological factors of HBL.

Results

A substantial amount of HBL (164.00 ± 112.02 ml, 40.65% of total blood loss (TBL)) occurred after transpedicular screw internal fixation. Multivariate linear regression analysis revealed that HBL was positively associated with TBL (p < .001), percentage of vertebral height loss (VHL) (p < .001), percentage of vertebral height restoration (VHR) (p < .001), numbers of fractured vertebrae (P = .013), and numbers of fixed vertebral segments (P = .002).

Conclusion

A large amount of HBL was incurred in patients undergoing MIPTSF in thoracolumbar fracture. More importantly, TBL, percentage of VHL, percentage of VHR, the numbers of fractured vertebrae and fixed vertebral segments were independent risk factors for HBL.

Short-Segment Pedicle Fixation of Traumatic Low Lumbar Fractures (L3-L5): Report of 36 Cases

STUDY DESIGN

Prospective review.

OBJECTIVE

The aim was to assess the efficacy and safety of short-segment pedicle fixation of low lumbar fractures (L3-L5).

BACKGROUND

Low lumbar fractures are relatively uncommon, and limited data exists regarding the management of these injuries. No previous studies have specifically examined the surgical management of L3-L5 fractures exclusively with pedicle fixation.

MATERIALS AND METHODS

We reviewed prospectively collected data of 36 patients who underwent short-segment pedicle fixation for low lumbar fractures at our institution between 1993 and 2018.

RESULTS

There was no worsening of neurological status following surgery, and three patients regained motor or sphincter function. Thirty-one (86.1%) patients went on to successful fusion. Three (8%) patients required reoperation. Four (11%) patients had surgical complications.

CONCLUSIONS

This large series provides information regarding the safety and efficacy of surgical management of low lumbar fractures with pedicle fixation. Following surgery, there was no neurological worsening and some patients regained neurological function. Low complication rates, low reoperation rates, and low pain levels at final follow-up provide evidence that the surgical management of low lumbar fractures utilizing short-segment pedicle fixation is safe and efficacious.