Microcirculation in open vs. minimally invasive dorsal stabilization of thoracolumbar fractures

Abstract

Standard open and percutaneous minimally invasive surgical procedures co-exist in the treatment of fractures of the thoracolumbar spine. Shorter skin incisions just above the pedicles are used in minimally invasive procedures. Full-length skin incisions and invasive preparations are applied in the standard open approach. While both methods show equivalent rates of intraoperative surgical complications and comparable clinical and radiological outcomes, blood loss and operation time have shown to be decreased in minimally invasive treatment. However, no study so far has investigated differences in microcirculation. This study hypothesized less impairment of microcirculation in the minimally invasive approach compared to the open approach and an improvement of microcirculation over time. A prospective cohort study was conducted using non-invasive laser-Doppler spectrophotometry (an O2C “oxygen to see” device) for measurement of cutaneous and subcutaneous blood oxygenation (SO2), haemoglobin concentration (Hb), and blood flow at depths of 2, 8, and 15 mm at six locations on the skin. Measurements were performed before surgery, 8 and 24 h after surgery, and 2, 4, 7, 12 and 20 days after surgery, however the number of patients measured decreased towards the later time points. Forty patients were included in the study, 20 with each approach (18 females and 22 males). Pair-wise comparison of the types of surgical procedure for each measurement point revealed a significantly higher flow value in the minimally invasive group at one of the measurement points located between the incisions (P = .041). The point-wise analyses of SO2 and Hb did not show significant differences between the approaches. In conclusion, significantly albeit moderately higher flow values could be found in minimally invasive procedures compared to open operations of thoracolumbar fractures in the area of skin that is spared by the incisions.

Trochanteric Femur Fractures: Application of Skeletal Traction during Surgery Does Not Alter Soft-Tissue Microcirculation

“…Ganse et al showed that, in proximal femur fractures, the surgery itself alters skin and subcutaneous microcirculation around the greater trochanter throughout the postoperative period, compared to the healthy leg. The same was previously demonstrated for calcaneal and thoracolumbar fractures, where microcirculation, in a minimally invasive approach, was compared to standard open fixation [17,18]. It is a common observation that microcirculation is altered after trauma [15,19].…”

Soft tissue microcirculation around the healthy Achilles tendon: a cross-sectional study focusing on the Achilles tendon and dorsal surgical approaches to the hindfoot

“…The O2C device as a tool for noninvasive detection of hemoglobin saturation and blood flow using laser Doppler technique and white light spectroscopy allows for valid and reproducible quantitative determination of microcirculatory parameters [ 19 – 24 ], as well as identification of possible influencing factors in healthy subjects [ 23 , 25 ]. Currently, O2C studies have provided evidence for altered soft tissue microcirculation after peripheral artery occlusive disease [ 26 ] as well as for individual healing tendencies depending on the microcirculatory parameters in patients with burns [ 27 , 28 ] and chronic diabetic foot ulcers [ 19 ].…”

“…Currently, O2C studies have provided evidence for altered soft tissue microcirculation after peripheral artery occlusive disease [ 26 ] as well as for individual healing tendencies depending on the microcirculatory parameters in patients with burns [ 27 , 28 ] and chronic diabetic foot ulcers [ 19 ]. In this context, recent data in the treatment of fractures of the thoracolumbar spine indicated differences in microcirculation between open and minimally invasive approaches [ 24 ]. High oxygen saturation and high blood flow values clearly contribute to a good prognosis of wound healing.…”

Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies

“…In a prospective, multi-institutional study on lumbar spine surgery in morbidly obese patients, improvement in back and leg pain, physical component score/mental component score, and life quality was observed with no divergence in post-operative complications between MIS-TLIF and open TLIF [ 59 ]. While in the other study, compared to open TLIF, MIS-TLIF improved blood flow in the incised skin with no change in levels of blood oxygen and hemoglobin [ 60 ]. In a long-term clinical follow-up for treatment of one-segment lumbar disc herniation, MIS-TLIF predominated conventional TLIF in efficaciously reduced blood loss, intramuscular pressure, operative time, mean return to work time, as well as visual analogue score (VAS) and ODI indices, implying pain relief [ 61 ].…”