Minimally Invasive Posterior Decompression Combined With Percutaneous Pedicle Screw Fixation for the Treatment of Thoracolumbar Fractures With Neurological Deficits

Zhang, Wei; Li, Haiyin; Zhou, Yue; Wang, Jian; Chu, Tongwei; Zheng, Wenjie; Chen, Bin; Li, Changqing

doi:10.1097/brs.0000000000001814

Cited by 51 publications

(34 citation statements)

References 36 publications

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“…This trend was implemented at any given spinal segments (cervical, thoracic, and lumbar), and for a wide range of pathologies, such as: degenerative stenosis, disc herniations, synovial cysts, traumatic or pathological fractures, and even deformities. [1][2][3][4][5][6] The use of the endoscope for lumbar discectomies (percutaneous endoscopic lumbar discectomy, PELD) was fostered by the development of high-resolution endoscopes, optics, and digital cameras which allowed to gain some edges over MISS performed with the aid of microscope or surgical loupes alone. Many different PELD techniques are available nowadays, they include the microendoscopic discectomy, as well as a number of system for endoscopic spine surgery.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study of Percutaneous Interlaminar Endoscopic Lumbar Sequestrectomy: A Modern Strategy to Tackle Medically-Refractory Radiculopathies and Restore Spinal Function

et al. 2019

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Objective: Angled scopes allow 360° visualization, which makes percutaneous endoscopic techniques (percutaneous endoscopic lumbar discectomy, PELD) particularly attractive for sequestrectomies, which entail the removal of extruded lumbar disc fragments that have migrated caudally or cranially between the ligaments, foramina, and neural structures, while preserving the disc. Although many different PELD techniques are currently available, not all of them are suitable for sequestrectomies; furthermore, long-term follow-up data are unfortunately lacking. Methods: A pilot study was conducted on a cohort of 270 patients with lumbar radiculopathy undergoing minimally invasive spine surgery (PELD or microdiscectomy), of whom only 7 were eligible for endoscopic interlaminar sequestrectomy with disc preservation. The patients' baseline conditions and clinical outcomes were measured with the Oswestry Disability Index and a visual analogue scale. Long-term follow-up was conducted using satisfaction questionnaires that were based on the MacNab criteria and administered by medical/nursing personnel not involved in their primary surgical management. Results: EasyGo system was eventually used in 5 PELD cases. No dural tears, infections, or nerve root injuries were recorded in patients undergoing sequestrectomy. Surgical events, including blood loss and overall length of hospital stay, did not differ significantly among the 270 patients. In the group treated with endoscopic sequestrectomy, no recurrences or complications were noted during a follow-up of 3 years, and an excellent degree of satisfaction was reported. Conclusion: We provide OCEBM (Oxford Centre for Evidence-Based Medicine) level 3 evidence that interlaminar endoscopic sequestrectomy is a tailored and well-tolerated surgical option; nonetheless, a cost-effectiveness analysis assessing the interval until return to working activities and long-term benefits is warranted.

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Section: Introductionmentioning

confidence: 99%

A Pilot Study of Percutaneous Interlaminar Endoscopic Lumbar Sequestrectomy: A Modern Strategy to Tackle Medically-Refractory Radiculopathies and Restore Spinal Function

et al. 2019

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“…PMIS is a type of minimally invasive surgery performed using a laparoscope, thoracoscope or endoscope, which causes fewer injuries and surgery-associated defects as compared with the COS procedure (8,26). It has been suggested that PMIS presents certain advantages for the treatment of patients with fractures in the thoracic spine (13,27). Thus, the present study compared the differences between PMIS and COS performed in patients with fractures in the thoracic spine.…”

Section: Discussionmentioning

confidence: 98%

“…Pan et al (29) have also indicated that treatment of children with supracondylar fracture of the humerus using PMIS decreased the recovery time, hospitalization days and blood transfusion rate. In addition, minimally invasive posterior decompression combined with percutaneous pedicle screw fixation has been demonstrated to achieve a similar effect with COS for the treatment of thoracolumbar fractures with neurological deficits (27). Furthermore, the efficacy and safety of simultaneous combined minimally invasive percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy was investigated in the treatment of partial staghorn calculi, and was observed to be more efficient compared with the conventional minimally invasive percutaneous nephrolithotomy monotherapy, without additional procedure-associated complications (30).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…Although the open posterior approach surgery can effectively fix the fractured vertebra, promote fracture healing, and reduce complications, it results in large incisions, significant blood loss, destruction of peripheral soft tissue, and complications such as back pain. The PPS system has obvious advantages in reducing soft tissue injury and postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Pedicle Screw Placement Aided by a New Drill Guide Template Combined with Fluoroscopy: An Accuracy Study

Deng

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate the accuracy of percutaneous pedicle screw (PPS) placement aided by a new drill guide template.Methods: The patients were divided into guide template group and conventional perspective group. In the conventional perspective group, the screws were placed by hand under fluoroscopy. In the guide template group, the screw placement was aided by a new drill guide template, and the drill guide template is designed according to the patient's ideal pedicle screw, but not based on skin morphology. The accuracy was evaluated by comparing the following parameters between the two groups: pedicle breach level, inclination angle deviation between the left and right screws, sagittal angle deviation between the left and right screws, and position deviation of the left and right screw entry points. The consistency of the postoperative screw angle and the corresponding guide template inclination angle was compared in the guide template group. The operative time, blood loss, and radiation times were compared between the groups.Results: A total of 146 patients (876 screws) were enrolled in our study including 79 (474 screws) in the guide template group and 67 (402 screws) in the conventional perspective group. The pedicle breach level in the guide template group (22/474) was significantly lower than that in the conventional perspective group (47/402) (P < 0.05). The position and direction deviations of the left and right screws in the guide template group (2.06 AE 1.02 mm, 1.23 AE 1.25 mm, 1.83 AE 1.49 ) were significantly less than those in the conventional perspective group (5.33 AE 2.99 mm, 4.32 AE 3.25 mm, 2.87 AE 1.56 ). The operation time, blood loss, and radiation times were significantly lower in the guide template group (80.49 AE 9.14 min, 50.42 AE 8.9 mL, 11.02 AE 2.44) than those in the conventional perspective group (108.1 AE 21.18 min, 71.7 AE 17.09 mL, 23.53 AE 4.54). There were no significant differences between the postoperative screw angle and the corresponding guide template angle in the guide template group.Conclusion: PPS placement aided by a new drill guide template yielded higher screw accuracy and less operative time, blood loss, and radiation exposure than traditional screw placement.

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Minimally Invasive Posterior Decompression Combined With Percutaneous Pedicle Screw Fixation for the Treatment of Thoracolumbar Fractures With Neurological Deficits

Abstract: 2.

Cited by 51 publications

References 36 publications

A Pilot Study of Percutaneous Interlaminar Endoscopic Lumbar Sequestrectomy: A Modern Strategy to Tackle Medically-Refractory Radiculopathies and Restore Spinal Function

A Pilot Study of Percutaneous Interlaminar Endoscopic Lumbar Sequestrectomy: A Modern Strategy to Tackle Medically-Refractory Radiculopathies and Restore Spinal Function

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

Percutaneous Pedicle Screw Placement Aided by a New Drill Guide Template Combined with Fluoroscopy: An Accuracy Study

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