Percutaneous, PMMA-augmented, pedicle screw instrumentation of thoracolumbar ankylotic spine fractures

Abstract

Introduction Fractures in the ankylotic spine may have an insidious presentation but are prone to displace with devastating consequences. The long lever arm of ankylosed spine fragments may lead to pulmonary and great vessel injury and is difficult to adequately immobilize. Conservative treatment will produce in many cases poor outcomes with high morbidity and mortality. Open surgical treatment is also fraught with technical difficulties and can lead to major blood loss and prolonged operative times. In recent years, percutaneous instrumentation of non-ankylotic spine fractures has gained popularity, producing similar outcomes to open surgery with shorter operative times and reduced blood loss and hospital length of stay. We describe our experience implementing these techniques in ankylotic spine patients. Methods We retrospectively retrieved from our hospital’s electronic health records all patients treated for thoracolumbar spine fractures between 2008 and 2015 with a diagnosis of ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). Operative and postoperative data, results, and complications were tabulated, and radiographic parameters were evaluated. Results Twenty-four patients with ankylotic spine disease underwent percutaneous augmented instrumentation between 2008 and 2015. The mean age was 76. All patients had at least one comorbidity. The mean number of ankylosed levels was 14. Mean operative time was 131 min. The average postoperative hemoglobin decrease was 1.21 gr/%, with only 4 patients requiring blood transfusion. 45.8% of the patients had postoperative medical complications. One patient (4.2%) had a superficial postoperative infection, and one patient died in hospital. The average hospital length of stay was 14.55 days. All patients retained their preoperative ASIA grades, and 3 improved one grade. All patients united their fractures without losing reduction. Conclusions PMMA-augmented percutaneous instrumentation is an attractive surgical option for this difficult patient subset, especially when compared to other available current alternatives.

Surgical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with ankylosing spondylitis

“…The clinical outcomes of our robot-assisted percutaneous xation technique are consistent with previous studies on minimally invasive surgery, demonstrating consistently favorable results [12,30,31]. The VAS and ODI values were 1.3 ± 1.0 and 11.8 ± 6.6%, respectively, at the most recent follow-up.…”

“…Barkay et al [39] demonstrated that postponing surgical intervention (> 72 hours) in elderly patients with spinal ankylosing disorders may lead to an increase in medical complications and mortality. In our study, surgery was delayed in 8 (67%) patients; however, no patients died, and the incidence of postoperative complications was 8.3%, which was lower than that reported in other studies [12,30,39]. This could potentially be attributed to the limited sample size of participants in our research or the use of robot-assisted technology, which improves work e ciency and promotes early rehabilitation.…”

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

“…Several case series have found that percutaneous instrumentation among patients with thoracolumbar fractures and underlying AS provide sufficient radiographic alignment without loss of reduction or need to convert to open surgery and provide similar clinical outcomes to open surgery 11,14,17–20 . Previous studies have also shown that percutaneous pedicle screw placement provides multiple benefits including decreased blood loss, decreased risk of infection, decreased paraspinal muscle damage, and decreased length of hospital stay (Table I) 21–28 . A meta-analysis comparing open versus minimally invasive techniques in thoracolumbar trauma found equivalent results in clinical and radiographic outcomes, with the advantage of decreased intraoperative blood loss and operative times offered by minimally invasive surgery 29 .…”

Surgical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with ankylosing spondylitis

“…In recent years, minimally invasive surgery has been recognized by the majority of doctors, especially for elderly AS patients with more underlying diseases. It can achieve better clinical results and reduce the occurrence of surgical complications [ 9 , 10 , 29 , 30 ]. Ye et al [ 9 ] demonstrated that minimally invasive surgery can achieve effects similar to those of traditional open surgery, while reducing bleeding, trauma, and postoperative complications.…”