Flexion-distraction injuries of the thoracolumbar spine: open fusion versus percutaneous pedicle screw fixation

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Flexion-distraction injuries occur due to distractive forces causing disruption of the posterior and middle spinal columns. These fractures classically consist of a fracture line through the posterior bony elements; involvement of the posterior ligamentous complex is, however, common. Surgical treatment is often required for these unstable injuries to avoid neurological deterioration and posttraumatic kyphosis, and the surgery traditionally consists of an open posterior approach with instrumented fusion. Percutaneous pedicle screw fixation for these injuries, with the goal of minimal tissue disruption and preservation of normal anatomy while achieving adequate stabilization, has recently been reported in the literature, but to date, a direct comparative study comparing open and percutaneous fixation has not been reported. The authors report their experience treating these fractures with both techniques and review the available literature.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients with flexion-distraction injury who were treated between May 2003 and March 2013 were prospectively followed. American Spinal Injury Association scores and degree of kyphotic angulation were recorded at admission, discharge, and follow-up. Data regarding intraoperative blood loss and operative time were obtained from a chart review. Patients treated with open versus minimally invasive procedures were compared.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The authors identified 39 patients who suffered flexion-distraction injuries and were treated at their institution during the specified period; one of these patients declined surgery. All had injury to the posterior ligamentous complex. Open surgical procedures with pedicle screw fixation and posterolateral fusion were performed in 27 patients, while 11 patients underwent minimally invasive pedicle screw placement. Overall, there was improvement in kyphotic angulation at the time of discharge as well as most recent follow-up in both the open surgery and minimally invasive surgery (MIS) groups. The authors found no significant difference in American Spinal Injury Association score or the degree of kyphotic angulation between the MIS and open surgery groups. There was a trend toward shorter operative time for the MIS group, and patients who underwent minimally invasive procedures had significantly less blood loss.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Minimally invasive percutaneous pedicle screw fixation appears to have similar efficacy in the treatment of flexion-distraction injuries and it allows for reduced blood loss and tissue damage compared with open surgical techniques. Therefore it should be considered as an option for the treatment of this type of injury.</jats:p></jats:sec>

Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies

“…There were two randomized studies [14,28] and 10 observational studies included [3,8,9,13,15,27,[29][30][31][32]. Of the 12 studies, there were seven prospective studies [8,9,14,[28][29][30][31] and five retrospective studies [3,13,15,27,32]. A total of 279 patients who underwent percutaneous instrumentation were compared with 340 patients who underwent conventional open instrumentation.…”

Effect of the percutaneous pedicle screw fixation at the fractured vertebra on the treatment of thoracolumbar fractures

“…Some authors [8][9][10] have proved that percutaneous pedicle screw fixation has some advantages, such as preservation of posterior musculature, less blood loss, shorter operative time, lower infection risk, less post-operative pain, shorter rehabilitation time as well as shorter hospital stay.…”

Traumatic thoracolumbar spinal injury: an algorithm for minimally invasive surgical management

“…The majority of the studies that reviewed this nonfusion technique involved follow-up that was too short to reveal this problem. 1,[3][4][5][6]7,10,11,13 In our algorithm, we suggest limiting the use of percutaneous nonfusion techniques to patients with hyperostotic disorders such as ankylosing spondylitis and DISH unless a planned hardware removal at a later date is planned after the fracture heals. We recommend that patients with TLICS scores of greater than 4 undergo instrumented fixation with a bony arthrodesis via either a conventional open or mini-open approach.…”

“…The authors provided only an average length of follow-up of 11.8 months for the MIS surgery group and did not disclose if any patients were lost to follow-up. 5 Wild et al 15 retrospectively compared 21 neurologically intact patients with thoracolumbar fractures, 11 of whom were treated with conventional open surgery and 10 of whom were treated with minimally invasive fixation without fusion. The authors routinely removed implants at an average of 10 months to avoid implant loosening and failure.…”