Neuronavigated Percutaneous Treatment of Thoracolumbar Spine Fractures

Abstract

Introduction Treatment goals of amielic thoracolumbar spine fractures are the stabilization of traumatized segment, possibly restoring the physiological spine curvature, and vertebral healing or fusion of the affected segment. Percutaneous minimally invasive techniques are becoming a viable option in the treatment of selected thoracolumbar fractures; intraoperative neuronavigation of biplanar fluoroscopy associated with preoperative CT scan allows precise pedicle insertion and reduces intraoperative X-ray exposure. Materials and Methods Over a period of 2 years, 43 patients with thoracolumbar fractures at our institution were elected for minimally invasive surgery using neuronavigated technique. All patients experienced one or two thoracolumbar fractures (varying from A3.1 to B2.3, according to the AO/Magerl classification) without neurological deficits. Pain profile was assessed by visual analog scale (VAS) and all radiological findings were evaluated with vertebral body index (VBI), vertebral body angle (VBA), and Cobb angle. Procedures used for treatment include kyphoplasty alone and short segment percutaneous pedicle screw fixation with or without vertebral body augmentation. All the procedures were performed under general anesthesia, but for collaborating patients who need kyphoplasty analgosedation was used. Clinical mean follow-up was 15 months (2–24 months) and has been assessed with VAS and the ability to return to their original lifestyle and/or occupation; radiographic postoperative evaluation consisted of X-ray for kyphoplasty patients and CT for those instrumented to determine the accuracy of screw placement. Results The mean surgical duration was 92 minutes (passing from 32 minutes for the fastest kyphoplasty to 170 minutes for the slowest fixation). There was no case of screw or needle malposition during kyphoplasty. Total radiation exposure was 54 seconds. Postoperatively, almost all the patients improved their symptoms and nobody needed reoperation because of postoperative complications, except for a case in which an initial screw pull-out was stopped with a second stage kyphoplasty. Conclusion Neuronavigation in minimally invasive spine surgery represents a viable solution for the treatment of amielic thoracolumbar fractures. Minimal invasive techniques have been shown to reduce blood loss, postoperative pain, and hospitalization; with the neuronavigated support, there is also a sensible reduction in X-ray exposure of patients and operative room operators.