The Outcome of Minimally Invasive Percutaneous Transpedicular Screw Fixation (TPSF) in Thoracolumbar Spine Fractures
DOI:
https://doi.org/10.36552/pjns.v26i3.773Abstract
Background & Objective: This study aimed to determine the outcome of percutaneous transpedicular screw fixation (TPSF) in patients with thoracolumbar fractures.
Material & Methods: A total of 157 patients with thoracolumbar fractures were included from the Department of Neurosurgery, LGH, PINS, Lahore. Patients were evaluated with plain X-rays, CT, and MRI scans. Neurological status was documented preoperatively and postoperatively. All patients were treated with Minimally Invasive Percutaneous Transpedicular screw fixation. Data for operative time and per-operative blood loss was obtained through the operative notes. The severity of postoperative pain and length of hospital stay were also documented.
Results: Out of 157 patients, 69.4% were male and 30.6% were female. The 141 (89.8%) were traumatic from road traffic accidents/falls, and 16 (10.2%) were pathologic. The 128 (81%) patients were discharged on the first day, 23(15%) were discharged on the second day, and 6(3.8%) on the third day. 79% of patients had a single level of spine fracture whereas, 20% had 2 spinal fracture levels. The average operative time for MIS percutaneous TPSF was 55 minutes. Postoperative pain was markedly reduced as compared to traditional open surgery and no patient had any new neurological deficit. The mean blood loss was 25 ml and none of the patients needed a postoperative blood transfusion.
Conclusion: Percutaneous transpedicular instrumentation is an ideal surgical approach for thoracolumbar spinal stabilization.
Keywords: Thoracolumbar Fractures, Percutaneous Transpedicular Screw Fixation, Minimally Invasive Spine Surgery, Road Traffic Accidents (RTA).
References
DeWald RL. Burst fracture of thoracic & lumbar spine. Clin Orthop Relat Res. 1984; 189: 150-61.
Smith HE, Anderson DG, Vaccaro AR, Albert TJ, Hilbrand AS, et al. Anatomy, Biomechanics and Classification of thoracolumbar Injuries. Seminars in Spine Surgery, 2010; 22: 2-7.
McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am. 1993; 75: 162–7.
Benson DR, Burkus JK, Montesano PX, Sutherland TB, McLain RF. Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne. J Spinal Disord. 1992; 5: 335–43.
Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine, 1983; 8 (8): 817-31.
Wood KB, Khanna G, Vaccaro AR, Arnold PM, Harris MB, et al. Assessment of two thoracolumbar fracture classification systems as used by multiple surgeons. The Journal of Bone & Joint Surgery, 2005; 87: 1423-1429.
Fehlings M.G., Perrin R.G. The timing of intervention in the treatment of spinal cord injury: a systematic review of recent clinical evidence Spine (Phila Pa 1976). 2006; 31 (11 Suppl.): S28-S35.
Launay O, Charles YP, Steib JP. Should post-traumatic thoracolumbar Frankel A paraplegia be operated as an emergency? Report of three cases and review of the literature Orthop Traumatol Surg Res. 2012; 98: 352-358.
Fehlings MG, Rabin D, Sears W, et al. Current practice in the timing of surgical intervention in spinal cord injury Spine (Phila Pa 1976). 2010; 35 (21 Suppl.): S166-S173.
Reinhold, M, Knop, C, Beisse, R. Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J. 2010; 19: 1657–1676. Doi: 10.1007/s00586-010-1451-5.
Frankel, HL, Hancock, DO, Hyslop, G. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. 1969; 7:179–192. doi:10.1038/sc.1969.30.
Wood KB, Li W, Lebl DR, et al. Management of thoracolumbar spine fractures. Spine J. 2014; 14: 145–64.
Khare S, Sharma V. Surgical outcome of posterior short segment trans-pedicle screw fixation for thoracolumbar fractures. J Orthop. 2013; 10: 162-167.
Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma: an overview. Indian J Orthop. 2015; 49: 72–82.
Rampersaud YR, Annand N, Dekutoski MB. Use of minimally invasive surgical techniques in the management of thoracolumbar trauma: current concepts. Spine (Phila Pa 1976). 2006; 31 suppl: S96–102.
Smith JS, Ogden AT, Fessler RG. Minimally invasive posterior thoracic fusion. Neurosurg Focus, 2008;
: E9.
Anderson S.D, Anderson D.G, Vaccaro A.R. Skeletal fracture demographics in spinal cord-injured patients. Arch Orthop Trauma Surg. 2004; 124: 193-196.
Andalib S, Mohtasham-Amiri Z, Yousefzadeh-Chabok Sh, Saberi A, Emamhadi M, Kouchakinejad-Eramsadati L, et al. Traumatic Spinal Cord Injuries Due to Motor Vehicle Accidents. Iran J Neurosurg. 2018; 4 (4): 213-218.
Tezer M, Erturer RE, Ozturk C, Ozturk I, Kuzgun U. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop. 2005; 29 (2): 78-82.
Reid DC, Hu R, Davis LA, Saboe LA. The nonoperative treatment of burst fractures of the thoracolumbar junction. The Journal of Trauma. 1988; 28 (8): 1188-1194.
Grossbach, Andrew J., Nader S. Dahdaleh, Taylor J. Abel, Gregory D. Woods, Brian J. Dlouhy, and Patrick W. Hitchon. "Flexion-distraction injuries of the thoracolumbar spine: open fusion versus percutaneous pedicle screw fixation", Neurosurgical Focus FOC. 2013; 35: 2.
Sun, XY, Zhang, XN, Hai Y. Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: a meta-analysis. Eur Spine J. 2017; 26: 1418-1431.
Kim D-Y, Lee S-H, Chung SK, Lee H-Y. Comparison of Multifidus Muscle Atrophy and Trunk Extension Muscle Strength, Spine, 2005; 30 (1): 123-129.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Pakistan Journal Of Neurological Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).
