Algorhythm for Use of Percutaneous Short Fixation of Fractures Involving the Thoracolumbar Junction and Lumbar Spine
- 1 Neurosurgery Department of University of Rome Sapienza, Rome, Italy.
- 2 Neurosurgery Department of University of Rome Sapienza, Rome, Italy.
- 3 Neurosurgery Department of University of Rome Sapienza, Rome, Italy.
Abstract
Study Design: Original article . Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures . Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junc tion, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algo rithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating ( MRI ) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fu sion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by per cutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.
- F. Magerl, “A Comprehensive Classification of Thoracic and Lumbar Injuries,” European Spine Journal, Vol. 3, No. 4, 1994, pp. 184-201. doi:10.1007/BF02221591
- T. McCormack et al., “The Load Sharing Classification of Spine Fractures,” Spine, Vol. 19, No. 15, 1994, pp. 1741-1744. doi:10.1097/00007632-199408000-00014
- T. Hashimoto, “Relationship between Traumatic Spinal Canal Stenosis and Neurologic Deficits in Thoracolumbar Burst Fractures,” Spine, Vol. 13, No. 11, 1988, pp. 12681272. doi:10.1097/00007632-198811000-00011
- W. Caspar, “A New Surgical Procedure for Lumbar Disc Herniation Causing Less Tissue Damage through a Microsurgical Approach,” Advanced Neurosurgery, Vol. 4, 1977, pp. 74-80. doi:10.1007/978-3-642-66578-3_15
- S. Hijigata, et al., “Percutaneous Diskectomy: A New Treatment Method for Lumbar Disc Herniation,” Journal of Toden Hospital Vol. 5, 1975, pp. 5-13.
- L. T. Khoo, “Minimally Invasive Percutaneous Posterior Lumbar Intebody Fusion,” Neurosurgery, Vol. 51, No. 5S, 2002, pp. S166-S181.
- A. Muller, “A Keyhole Approach for Endoscopically Assisted Pedicle Screw Fixation in Lumbar Spine Instability,” Neurosurgery, Vol. 47, No. 1, 2000, pp. 85-96. doi:10.1227/00006123-200007000-00019
- K. Muramatsu, “Postoperative Magnetic Resonance Imaging of Lumbar Disc Herniation: Comparison of Microendoscopic Discectomy and Love’s Method,” Spine, Vol. 26, No. 14, 2001, pp. 1599-1605. doi:10.1097/00007632-200107150-00022
- M. Altay, “Treatment of Unstable Thoraco-Lumbar Junction Burst Fractures with Short-or Long-Segment Posterior Fixation in Magerl Type A Fractures,” European Spine Journal, Vol. 16, No. 8, 2007, pp. 1145-1155. doi:10.1007/s00586-007-0310-5
- P. L. Sanderson, “Short Segment Fixation of Thoracolumbar Burst Fractures without Fusion,” European Spine Journal, Vol. 8, No. 6, 1999, pp. 495-500. doi:10.1007/s005860050212
- X. Y. Wong, “Kyphosis Recurrence after Posterior ShortSegment Fixation in Thoraco-Lumbar Burst Fractures,” Journal of Neurology, Spine, Vol. 8, No. 3, 2008, pp. 246-254.
- M. Aebi, et al., “AO ASIF Priciples in Spine Surgery,” Springer-Verlag, Berlin, 1998, pp. 1-143. doi:10.1007/978-3-642-58824-2_1
- F. Denis, et al., “The Three Column Spine and Its Significance in the Classification of an Acute Thoracolumbar Spinal Injuries,” Spine, Vol. 8, No. 8, 1983, pp. 817-831. doi:10.1097/00007632-198311000-00003