Beneficial effects of percutaneous minimally invasive surgery for patients with fractures in the thoracic spine

Abstract

Percutaneous minimally invasive surgery (PMIS) is the most common surgical procedure used in patients with fractures in the thoracic spine. In the present study, the benefits of PMIS compared with the conventional open surgery (COS) were investigated in patients with thoracic spine fractures. A total of 84 patients were recruited in the current analysis. Inflammatory responses were measured in all patients subsequent to PMIS and COS. It was demonstrated that PMIS produced reduced inflammatory responses as compared with COS in clinical patients. In addition, the results revealed that kyphosis, anterolisthesis and the neurological state were significantly improved in patients subjected to PMIS compared with those receiving COS (P<0.01). The mean values of bone reduction and fracture correction loss were similar in the PMIS and COS groups (4.5 degrees). Furthermore, the outcomes indicated that the sensitivity for fracture localization to the correct vertebra was 0.90 in PMIS and 0.92 in COS (P>0.05). It was observed that patients who had undergone PMIS required reduced hospitalization time compared with the COS-treated patients (P=0.026). Additionally, the mean bleeding volume during surgery was 538 ml in the PMIS patients and 845 ml in the COS patients. Regarding physical activity, patients who underwent PMIS were relative more active compared with the COS patients (P=0.038) in a 14-day observation. In conclusion, the current clinical analysis indicated that PMIS was more beneficial for the treatment of patients with fractures in the thoracic spine, and the study provided further evidence for the management thoracic spine injuries.

A Comparative Study on Efficacies of Posterior Microscopic Mini-open and Open Technique for Thoracolumbar Burst Fractures Accompanied With Severe Traumatic Spinal Stenosis

“…MOT combines the advantages of minimally invasive procedures and open surgeries: a) percutaneous pedicle screw xation and fenestration of the vertebral lamina were performed via the minimally invasive incisions maximizing protected the paraspinal muscle and the posterior ligamentous complex (PLC), so that it can maintain thoracolumbar segmental stability and reduce post-operative pain and bleeding volume [4]; b) the fracture fragments can been directly and indirectly pressed into the fractured vertebral body using the L-shaped operative tool and the elastic tension of the posterior longitudinal ligament; c) the anterior and middle column satisfactory reduction and adequate bone graft can achieve via the spinal canal (Figure 2). In these studies, the postoperative PHR, Cobb angles, MSDCR were improved compared with preoperative values (P<0.05).…”

“…Decompression surgery can help patients limit their secondary spinal cord injury and improve their neurological recovery after acute spinal cord injury. Short-segment posterior xation, especially percutaneous minimally invasive xation, for thoracolumbar fracture are well-accepted [3][4][5][6], but it is di cult to decompression and bone grafting for patients with severe traumatic spinal canal stenosis resulting from thoracolumbar burst fractures, when mid-sagittal canal diameter compression ratio (MSDCR)>50% [3,7].…”

Traumatic Fractures of the Thoracic Spine

“…Given the increase in percutaneous surgical techniques for spinal surgery, the need is under consideration for extending posterior spondylodesis beyond the realms of exclusive instrumentation. Thus percutaneous posterior stabilisation of the ThSp in comparison with open procedures offers several advantages: it is associated with less inflammatory reaction, less intraoperative blood loss, shorter hospital stay and earlier return to activities of every-day life, without increasing the risk of screw misplacements [42,43]. However, the percutaneous technique is predominantly suitable for pure instrumentations, while posterior fusion procedures are usually performed using an open technique.…”

“…Perkutane InstrumentierungGerade im Rahmen der zunehmenden Etablierung perkutaner Operationstechniken an der Wirbelsäule wird die Notwendigkeit einer dorsalen Spondylodese über die reine Instrumentierung hinaus diskutiert. So bieten perkutane dorsale Stabilisierungen an der Brustwirbelsäule im Vergleich zu offenen Verfahren mehrere Vorteile: Sie gehen mit einer geringeren inflammatorischen Reaktion, weniger intraoperativem Blutverlust, kürzerer Hospitalisationszeit und früherer Rückkehr zu den Aktivitäten des Alltags einher, ohne die Gefahr von Schraubenfehllagen zu erhöhen[42,43]. Jedoch bietet sich die perkutane Technik vorwiegend für reine Instrumentierungen an, während dorsale Fusionsoperationen in aller Regel in offener Technik durchgeführt werden.Instrumentierung vs. FusionBetrachtet man thorakolumbale Frakturen generell, so gehen offene Instrumentierungen ohne Fusion schneller und mit geringerem Blutverlust als offen instrumentierte Spondylodesen vonstatten[44,45].…”

Biomechanics and clinical outcome after posterior stabilization of mid-thoracic vertebral body fractures: a systematic literature review

“…There is also some evidence that percutaneous posterior stabilization of thoracic spine fractures is associated with a reduced inflammatory response, less bleeding, shorter hospitalisation time and earlier return to activities of daily living [20,42].…”