Minimally Invasive Techniques in the Surgical Management of Traumatic Pediatric Thoracolumbar Fractures

Abstract

BackgroundThoracolumbar (TL) fractures are uncommon injuries in children. While surgical treatment is recommended for unstable TL fractures, there is no consensus on the appropriate surgical treatment. We present a case series of pediatric patients with traumatic TL fractures treated with minimally invasive (MI) surgical techniques. We discuss our early experience and technical challenges with navigation and robot-assisted (RA) fixation, which has not been reported in young children. MethodsA retrospective review of a prospectively maintained trauma database from February 2018-February 2023 of all pediatric patients (< 18 years old) undergoing percutaneous fixation for unstable TL fractures was performed. MI techniques included fluoroscopy and/or navigation-guided or RA. Details of the clinical course, radiographic findings and technical challenges were reviewed. ResultsA cohort of 12 patients with ages ranging from 4-17 years of age were identified. There was a total of 6 (50%) Chance fractures, 2 (16%) pars, 2 (16%) pedicles, 1 (8%) burst, and 1 (8%) other fracture. 9 patients had fractures involving the lumbar spine and the remaining 3 had thoracic fractures. In all cases, percutaneous pedicle screws were placed above and below the fracture with the use of neuro-navigation or RA navigation (n=2). Blood loss was less than 30 milliliters (ml) for single level fractures and instrumented fusion. Two patients had hardware-related complications. At follow-up, (mean 9.67 months from surgery) most of the radiologic imaging showed stable alignment and patients were doing well clinically. ConclusionsOur early experience shows that short segment instrumentation through a MI approach is a safe and effective surgical option for young pediatric patients with good clinical outcomes and favorable radiographic post-operative finding.