Assessment of Percutaneous Pedicle Screw Fixation in Management of Traumatic Thoracolumbar Spine Fractures; Local Study at Suez Canal University Hospital

Mohamed Elkazaz,Mohamed Hasanein

doi:10.21608/esj.2017.5635

Abstract

Background Data: Management of thoracolumbar fractures using the traditional posterior approach is associated with extensive paravertebral muscles damage and high postoperative morbidity. Minimally invasive percutaneous pedicle screw fixation is a highly valuable alternative for minimizing approach related morbidity. This technique ensures preservation of posterior musculature, less blood loss, less postoperative pain and shorter hospital stay.Purpose: To evaluate efficacy of percutaneous pedicle screw fixation in the treatment of traumatic thoracolumbar fractures.Study design: Descriptive cohort clinical case study.Patients and Methods: Thirty patients aged 18 to 50 years, with thoracolumbar fractures (AO types A1, A2 & A3) and neurologically intact underwent percutaneous pedicle screw fixation using Medtronic longitude II system. Patients with kyphotic deformity >45o, body mass index (BMI) >30, or osteoporotic spine were excluded. Back pain scores on visual analogue scale (VAS) and radiological parameters (Cobb’s angle, vertebral height loss, and anterior vertebral wedging) were compared pre and postoperatively. At final follow up, clinical outcome was assessed based on modified Macnab criteria.Results: The mean operative time was 135 minutes, and the mean intraoperative blood loss was 115 ml. The average preoperative VAS score of back pain was 5 and improved to 2.8 postoperatively. Mean hospital stay was 4 days. Patients were followed up for 8 to 12 months. Preoperative mean Cobb’s angle was 10.8o and improved to 5.6o postoperatively. The rate of misplaced screws was 11.8%. Based on the modified Macnab criteria, the final clinical outcome was excellent in 12, good in 16, and fair in 2 patients with a general patient satisfaction rate (excellent to good recovery) of 93%.Conclusion: our data suggest that this minimally invasive technique is safe and effective treatment in AO type A thoracolumbar fractures without neurological compromise. (2017ESJ128)

Highlights

The transition from the relatively stiff thoracic spine to the more dynamic lumbar spine subjects the thoracolumbar spine to significant biomechanical stress.[29]
Injuries of the thoracolumbar spine ranges from compression fractures to flexion distraction injuries or fracture dislocation which can result in significant disability, deformity and neurological deficits.[12]
The aim of the current study is to evaluate the efficacy and safety of percutaneous pedicle screw fixation in the management of relatively stable thoracolumbar fractures without neurologic compromise

Summary

Introduction

The transition from the relatively stiff thoracic spine to the more dynamic lumbar spine subjects the thoracolumbar spine to significant biomechanical stress.[29] This causes fractures of this region to be the commonest injury of the vertebral column, resembling nearly 60% of all traumatic spinal fractures.[10,18] Injuries of the thoracolumbar spine ranges from compression fractures to flexion distraction injuries or fracture dislocation which can result in significant disability, deformity and neurological deficits.[12] Management of thoracolumbar fractures aims at stabilisation of the traumatized segments to achieve sound vertebral healing This can be ascertained by using pedicle screw fixation that allows rigid stable constructs, earlier mobilization, and better deformity correction through providing three column spinal fixation.[10] The efficacy and safety of traditional open techniques for pedicle screw placement has been well documented.[29] open techniques require extensive paravertebral muscle dissection and retraction which results in muscle denervation, de-vascularization, and. Patients and Methods: Thirty patients aged 18 to 50 years, with thoracolumbar fractures (AO types A1, A2 & A3) and neurologically intact underwent percutaneous pedicle screw fixation using

Objectives

Methods

Results

Conclusion