Abstract
BackgroundEach year, there are approximately 5 million new vertebral fractures worldwide. Being a mobile flexible segment that is prone to severe stresses and loads, thoracolumbar fractures are considered one of the most controversial and challenging fracture types to manage.ObjectiveThe aim of this study is to explore the technique and to evaluate feasibility, safety, and outcome of percutaneous transpedicular fixation in the management of thoracolumbar fractures.MethodsThis study was carried out in the period between May 2016 and June 2017, where 20 consecutive patients with thoracolumbar fractures, based on TLICS scoring and neurological status, underwent a posterior percutaneous transpedicular fixation. The mean age was 33.85 years, range 20–49 years. Patients were followed up for 12 months. Patients had their clinical outcomes reviewed and evaluated in terms of cosmesis by visual analog scale (VAS) and in terms of Cobb angle correction.ResultsThe length of the procedure varied from 120 to 180 min with mean time of 154.50 min. There was no significant blood loss in all cases. The volume of blood loss ranged from 150 to 200 cc with mean loss of 174.25 cc.No major intraoperative complications happened in our study cases. Six cases had only one laterally malpositioned screw each. All cases returned to their previous activity without limitations (E5). Those who were completely pain free (F5) were 15 patients. Only five patients were suffering from moderate pain (F4). The Prolo scale was either 9 or 10 with mean of 9.60.ConclusionBy comparing our results with other studies, we found more or less equivalence in terms of neurological recovery, functional outcome, fusion rate, and maintenance of correction gain. However, the cosmesis scores for patients in the study were great.
Highlights
Spine fractures represent only a minority in all trauma patients, their influence on the patients, social and financial environment is more significant than other injuries [1].In the last 20 years, interest in spine fractures grew because new and advanced surgical treatment options were established
The paraspinal muscle dissection involved in open spine surgery can cause muscular denervation, increased intramuscular pressure, Elenany et al Egyptian Journal of Neurosurgery (2019) 34:40 ischemia, necrosis, and revascularization injury resulting in muscle atrophy and scarring, often associated with prolonged postoperative pain and disability [4]
The upper lumbar region was once more the site most frequently involved in a study by Keen [15] and a another study done by Erturer et al [16] where the upper lumbar region was involved in about 57.2% of spinal fractures
Summary
Spine fractures represent only a minority in all trauma patients, their influence on the patients, social and financial environment is more significant than other injuries [1]. In the last 20 years, interest in spine fractures grew because new and advanced surgical treatment options were established. Conventional open spine surgery has several reported limitations including extensive blood loss, postoperative muscle pain, and infection risk. The paraspinal muscle dissection involved in open spine surgery can cause muscular denervation, increased intramuscular pressure, Elenany et al Egyptian Journal of Neurosurgery (2019) 34:40 ischemia, necrosis, and revascularization injury resulting in muscle atrophy and scarring, often associated with prolonged postoperative pain and disability [4]. Being a mobile flexible segment that is prone to severe stresses and loads, thoracolumbar fractures are considered one of the most controversial and challenging fracture types to manage
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