Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases

Abstract

Purpose Posterior multilevel fixation of traumatic instability in ankylosing spinal disease (ASD) can be performed by open surgery (OS) or minimally invasive surgery (MIS). We investigated whether both methods differ based on the reduction results and perioperative parameters. Methods In this retrospective cohort study, OS and MIS groups were investigated. The bisegmental Cobb angles and dislocation angles were measured using pre- and postoperative CT images, and the initial malalignment and achieved reduction were calculated. Cut-seam time, calculated blood loss, transfusion number, fluoroscopy time, pedicle screw placement accuracy, duration of ICU stay, in-patient stay, and complications (bleeding, postoperative thrombosis and embolism, and postoperative mortality) were recorded. Results Seventy-five ASD patients with spine fractures (Ø 75 ± 11 years, male: 52, female: 23) (MIS: 48; OS: 27) were included in this study. The extent of reduction did not differ in the OS and MIS groups (p = 0.465; MIS:− 1 ± 3°, OS:−2 ± 6°). The residual postoperative malalignment angle was not significantly different (p = 0.283). Seventy-eight of the implanted screws (11%) showed malpositioning. No difference was found between OS and MIS (MIS, 37 [7%]; OS, 41 [16%]; p = 0.095). MIS was associated with less blood loss (OS: 1.28 ± 0.78 l, MIS: 0.71 ± 0.57 l, p = 0.001), cut-seam time (MIS: 98 ± 44 min, OS: 166 ± 69 min, p < 0.001), and hospital stay (MIS: Ø14 ± 16 d, OS: Ø38 ± 49 d, p = 0.02) than OS. Conclusion OS and MIS show equally limited performance in terms of the fracture reduction achieved. The MIS technique was superior to OS based on the perioperative outcome. Therefore, MIS should be preferred over OS for unstable spinal injuries, excluding C-type fractures, in ASD patients without neurological impairment.

Georg Schmorl prize of the German spine society (DWG) 2022: current treatment for inpatients with osteoporotic thoracolumbar fractures—results of the EOFTT study

“…Considering the 157 patients treated with short-segmental posterior stabilization, the majority of surgeries were performed via MIS. This is in accordance with the recommendations published in the literature based on the lower morbidity and lower blood loss associated with MIS [24][25][26]. The dominant treatment strategy in the included patients was hybrid stabilization, including posterior shortsegmental stabilization and cement augmentation of the fractured vertebral body.…”

Reduction and Stabilization of an Extension-Distraction Injury in a Patient with Ankylosing Spondylitis

“…3 Preoperative computed tomography (CT) scan in the sagittal plane and lateral intraoperative radiographs depicting complete, closed reduction of fracture. with thoracic or lumbar fractures in the setting of AS and found significantly decreased average operative time, intraoperative blood loss, and length of postoperative hospital stay using minimally invasive techniques, without any difference in quality of reduction or accuracy of screw placement (Table I) 11,24,25,[30][31][32][33] . Finally, percutaneous screw placement in the setting of a deformed spine may be challenging because traditional landmarks used to guide safe implant placement may be distorted or absent 8 .…”

Perioperative outcome of minimally invasive stabilisation of bilateral fragility fractures of the sacrum: a comparative study of bisegmental transsacral stabilisation versus spinopelvic fixation

“…Consequently, surgery should be kept as short as possible. Vanderschot et al reported a mean operation time of 60 min for the implantation of a single transsacral rod in 19 patients [16]. In our cohort of 24 geriatric patients, the insertion of two transsacral bars took an average of only 72 min.…”

“…This includes adequate fracture stabilisation for sufficient relief of symptoms. At the same time, surgical invasiveness and perioperative blood loss should be kept to a minimum to prevent haemorrhagic circulatory depression with resulting organ dysfunction such as prerenal renal failure [16].…”

“…This is the advantage of calculation of perioperative blood loss based on the pre-and postoperative Hb balance capturing both the external and internal blood loss that occurs in the time window between the pre-and postoperative blood collection [20]. For example, Kohler et al used this method in patients with unstable thoracolumbar vertebral fractures who underwent minimally invasive multilevel dorsal stabilisation, and found a mean blood loss of 700 mL [16]. Good et al calculated a mean blood loss of 1426 mL for the implantation of knee endoprostheses [15].…”