Minimally invasive surgery for thoracolumbar spinal trauma

Abstract

The indications for operative intervention after thoracolumbar spine trauma have been well described. Advances in minimally invasive techniques, including percutaneous pedicle screw fixation and mini-open anterolateral retractor-based approaches can improve surgical outcomes when appropriately applied by reducing blood loss, operative duration and post-operative pain. Moreover, they allow for theoretical advantages by preservation of muscular and skeletal blood supply and innervation that is typically lost during the muscular dissection of open approaches. For thoracolumbar spine fractures, percutaneous fixation allows for internal bracing of unstable fractures during healing while maintaining sagittal alignment. In instances of neurological compromise from fracture retropulsion, corpectomies may be required, and mini-open lateral approaches adopted from degenerative disease applications allow for a minimally invasive manner to treat the defect. These further allow for placement of wide rectangular-footprint expandable vertebral body replacement devices to provide anterior column support. We believe this allows for lower rates of subsidence and helps to maintain the biomechanical integrity necessary to prevent post-traumatic malalignment and kyphosis. Together, these minimally invasive techniques combined supply the spine surgeon with a minimally invasive armamentarium to treat nearly all thoracolumbar spine trauma. Surgeons should be comfortable with the strengths and shortcomings of these approaches in order to successfully apply them for this pathology.

Minimally invasive lateral corpectomy for thoracolumbar traumatic burst fractures

“…MI techniques have shown benefits over open corpectomies, both in our data here and in prior studies. 11,[14][15][16]26 Thus, we believe the addition of anterior column reconstruction in the management of burst fracture, using an MI technique, has clear benefit to the patient.…”

“…12,13 To our knowledge, few studies have examined the role of the MI lateral approach accompanied by anterior column reconstruction (MI lateral corpectomy) in a trauma population. [14][15][16] The indications for surgery in thoracolumbar trauma have evolved with improvements in diagnostic testing. The thoracolumbar injury classification and severity (TLICS) system characterizes fracture morphology, posterior ligamentous complex (PLC) integrity, and neurological status.…”

Comparison of the modified Wiltse's approach with spinal minimally invasive system and traditional approach for the therapy of thoracolumbar fracture

“…In addition, patients who underwent conservative treatment experience poor quality of life and high nursing costs. The pedicle screw system, especially the minimally invasive internal fixation surgery, enables faster recovery of the after internal fixation and patients can immediately resume their normal activities of daily living [ 5 ] .…”

Appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine using c-arm fluoroscopy: a cadaveric study 

“…Although the use of three-dimensional computed topography (CT) navigation during surgery can effectively reduce the rate of injury to articular process joints, it has not yet been widely promoted in Chinese hospitals because of its high cost and the high-end technology required for navigation, and most hospitals still use two-dimensional C-arm X-ray machines for the positioning of percutaneous pedicle screws under uoroscopy. Anatomical imaging studies of vertebral pedicles have demonstrated that from L1 to L5, the transverse inclination angle of the pedicle gradually increases, and the transverse diameter of the pedicle isthmus gradually widens [2][3][4] . The distance between the projection of the pedicle axis on the back of the corpus vertebrae and the ipsilateral articular process joint gradually increases.…”