Minimal-invasive perkutane Instrumentation bei Wirbelsäulenfrakturen

Abstract

When operating unstable spine fractures by an open dorsal approach, detachment of paravertebral muscles results in bleeding and later functional disturbances. Long incisions over spinous processes cause pain and later cosmetic issues. With the sextant of Medtronic a system is at our disposal which permits a percutaneous approach with pedicle screws and longitudinal supports by a target device via six small incisions. From 15 November 2007 until 15 May 2008, 36 unstable spine fractures were treated by a minimally invasive technique; 14 men and 22 women were treated. The average age was 61 years (22-88 years). According to the Magerl classification there were mostly A3.3 fractures. The average incision-closure time was 42 min (14-96 min) with an average X-ray exposure time of 3.35 min (1.5-7 min). Blood loss was 10-20 ml and average hospital stay was 11 days. Pain judged according to a visual analog scale decreased from 6.1 to 1.4 points. Incorrect screw positions without clinical relevance were seen in 2% without necessity for revision. From 1 February 2007 until 15 November 2007, 40 patients (24 men, 16 women, average age 53 years) with unstable spine fractures were treated by the same surgeons by open dorsal instrumentation. The average operation time in this control group was 91 min and the average time at hospital 15.5 days. Percutaneous instrumentation with cannulation of pedicles with a guide wire under X-ray control permits a safe application while preserving soft tissues without relevant blood loss. Operating times can be drastically reduced compared with the open technique. The implants are more expensive but pay for themselves by shorter stays in the OR and hospital.