Short Percutaneous Posterior Instrumentation: a Reliable Option in the Treatment of Thoraco-lumbar post-traumatic Spinal Fracture

Abstract

IntroductionThere are several options to treat instable thoraco-lumbar spinal fractures without spinal cord involvement. A short percutaneous posterior instrumentation [SPPI] (i.e., involving only one level up and one level below the lesioned level) is a fast choice, safer than other more invasive options at the cost of an apparent less efficacy in restoring proper alignment or in the ability to maintain good results in the long term. Aim of our present contribution is to report the incidence of worsening during time of spinal alignment features in patients treated with SPPI. Material and MethodsBetween September 2010 and August 2015, among 230 consecutive operations for instable post-traumatic thoraco-lumbar spinal fractures, we performed 47 SPPI and 130 other percutaneous instrumentations (4 levels or more). Fractures were defined according to the AO classification; vertebral body index [VBI], vertebral body angle [VBA] and Cobb's angle [CA] were measured before, immediately after operation (i.e., in the first two post-op days) at 1 month- and at 12 month-follow-up. All data were drawn from multi-slice high-definition CT-scans. Local ethical committee approved the study design. Results were also stratified according to the class of fracture and number of blocked levels (3, 4 or more). ResultsIn the SPPI-cases we found preop the following mean values: VBI 0,67, VBA -16,5, CA -9,5; at 12 months follow-up (26 patients out of 35) mean values were: VBI 0,84,VBA -14,8 and CA -5,4 with changes statistically non significant between immediate post-op and 1 year follow-up. ConclusionIn our hands SPPI proved to be an effective therapeutic option. No significant kyphotic worsening was observed during the first year post-op. Parallel sections of the present study and prolongement of the observational time will allow us to compare SPPI with longer posterior instrumentations in non spinal cord-lesioned thoraco-lumbar fractured patients.