Abstract
Standard open and percutaneous minimally invasive surgical procedures co-exist in the treatment of fractures of the thoracolumbar spine. Shorter skin incisions just above the pedicles are used in minimally invasive procedures. Full-length skin incisions and invasive preparations are applied in the standard open approach. While both methods show equivalent rates of intraoperative surgical complications and comparable clinical and radiological outcomes, blood loss and operation time have shown to be decreased in minimally invasive treatment. However, no study so far has investigated differences in microcirculation. This study hypothesized less impairment of microcirculation in the minimally invasive approach compared to the open approach and an improvement of microcirculation over time. A prospective cohort study was conducted using non-invasive laser-Doppler spectrophotometry (an O2C “oxygen to see” device) for measurement of cutaneous and subcutaneous blood oxygenation (SO2), haemoglobin concentration (Hb), and blood flow at depths of 2, 8, and 15 mm at six locations on the skin. Measurements were performed before surgery, 8 and 24 h after surgery, and 2, 4, 7, 12 and 20 days after surgery, however the number of patients measured decreased towards the later time points. Forty patients were included in the study, 20 with each approach (18 females and 22 males). Pair-wise comparison of the types of surgical procedure for each measurement point revealed a significantly higher flow value in the minimally invasive group at one of the measurement points located between the incisions (P = .041). The point-wise analyses of SO2 and Hb did not show significant differences between the approaches. In conclusion, significantly albeit moderately higher flow values could be found in minimally invasive procedures compared to open operations of thoracolumbar fractures in the area of skin that is spared by the incisions.
Highlights
Fractures of the spine are common and require operative treatment when unstable
It is assumed that the minimally invasive (MI) approach minimizes soft tissue injury, blood loss, and pain, as well as complications from decreased blood supply such as infections related to a changed local milieu with local hypoxia and acidosis that decreases the local function of the immune system and thereby supports bacterial growth [1]
A comparison of microcirculation in MI vs. Standard open (SO) operations of thoracolumbar spinal fractures was the aim of the present study
Summary
Fractures of the spine are common and require operative treatment when unstable. Standard open (SO) and percutaneous minimally invasive (MI) procedures co-exist in daily practice. While the MI technique is thought to cause less blood loss, pain, and damage to the surrounding tissue, and is thought to allow for shorter hospitalization and a shorter duration of the surgical procedure, the clinical and radiological outcomes seem to be comparable to the SO approach [3,4,5,6]. The aim of the present study was to compare blood flow, haemoglobin (Hb) concentration, and oxygen saturation (SO2) in the area surrounding the site of the surgical procedure in both approaches to evaluate and compare parameters of microcirculation throughout the surgical treatment process over time. We hypothesized (1) higher values of tissue oxygen saturation, haemoglobin content and blood flow in the MI approach compared to the SO approach measured at different depth levels and (2) a recovery of microcirculation parameters over time following the healing process
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