M Pishnamaz1, P Lichte2, R M Sellei2, H-C Pape2, P Kobbe2. 1. Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland. mpishnamaz@ukaachen.de. 2. Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
Abstract
OBJECTIVE: Operative treatment of vertebral fractures is focused on stabilization of the spine and decompression of the spinal cord and nerves. In German-speaking countries, it is common to restore the sagittal profile by fracture reduction. The use of percutaneous systems has been limited due to inferior reduction possibilities compared to open systems. The improved reduction options offered by newer percutaneous systems extend their application to highly deformed fractures. INDICATIONS: Unstable thoracic, lumbar and lumbosacral spine fractures; unacceptable spinal deformities. CONTRAINDICATIONS: Need for open decompression or cross-bracing; relative contraindication: obesity or cachexia. SURGICAL TECHNIQUE: 3 cm skin incision 1.5 cm lateral to the radiological border of the pedicle. Incision of the fascia and blunt preparation to the facet joints. Guidewire placement via fluoroscopy. Tapping and cannulated screw setting. Insertion of the longitudinal rods and reduction using special reduction tools. Rod fixation with locking caps, wound closure, dressing. POSTOPERATIVE MANAGEMENT: Pain-related mobilization, physiotherapy, indication for anterior fusion to be considered. RESULTS: In 2012, 80 patients (42 female, 38 male) with a mean age of 59.7 years received posterior stabilization (27 open, 53 percutaneous). Intraoperative radiation was significantly higher in the percutaneous group compared with the open group (percutaneous: 212 s; open: 146 s; p < 0.05), while the length of surgical treatment was significantly shorter (percutaneous: 107 min; open: 143 min; p < 0.05). Accuracy of screw positioning and the amount of reduction was similar in both groups. Major complications did not occur.
OBJECTIVE: Operative treatment of vertebral fractures is focused on stabilization of the spine and decompression of the spinal cord and nerves. In German-speaking countries, it is common to restore the sagittal profile by fracture reduction. The use of percutaneous systems has been limited due to inferior reduction possibilities compared to open systems. The improved reduction options offered by newer percutaneous systems extend their application to highly deformed fractures. INDICATIONS: Unstable thoracic, lumbar and lumbosacral spine fractures; unacceptable spinal deformities. CONTRAINDICATIONS: Need for open decompression or cross-bracing; relative contraindication: obesity or cachexia. SURGICAL TECHNIQUE: 3 cm skin incision 1.5 cm lateral to the radiological border of the pedicle. Incision of the fascia and blunt preparation to the facet joints. Guidewire placement via fluoroscopy. Tapping and cannulated screw setting. Insertion of the longitudinal rods and reduction using special reduction tools. Rod fixation with locking caps, wound closure, dressing. POSTOPERATIVE MANAGEMENT: Pain-related mobilization, physiotherapy, indication for anterior fusion to be considered. RESULTS: In 2012, 80 patients (42 female, 38 male) with a mean age of 59.7 years received posterior stabilization (27 open, 53 percutaneous). Intraoperative radiation was significantly higher in the percutaneous group compared with the open group (percutaneous: 212 s; open: 146 s; p < 0.05), while the length of surgical treatment was significantly shorter (percutaneous: 107 min; open: 143 min; p < 0.05). Accuracy of screw positioning and the amount of reduction was similar in both groups. Major complications did not occur.