Percutaneous Pedicle Screw Stabilization: Surgical Technique, Fracture Reduction, and Review of Current Spine Trauma Applications

Alander, Dirk H.; Cui, Shari

doi:10.5435/jaaos-d-15-00638

Cited by 22 publications

(6 citation statements)

References 28 publications

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“…Percutaneous instrumentation is rapidly becoming the treatment of choice for thoracolumbar spine fractures [ 17 ] enabling reduction and fixation of complex fractures with shorter operative times, lower blood loss, and reduced complication rates [ 18 ]. Being a non-fusion technique, the instrumentation can be removed after fracture union in some cases, enabling partial restoration of the range of motion [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous, PMMA-augmented, pedicle screw instrumentation of thoracolumbar ankylotic spine fractures

et al. 2021

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Introduction Fractures in the ankylotic spine may have an insidious presentation but are prone to displace with devastating consequences. The long lever arm of ankylosed spine fragments may lead to pulmonary and great vessel injury and is difficult to adequately immobilize. Conservative treatment will produce in many cases poor outcomes with high morbidity and mortality. Open surgical treatment is also fraught with technical difficulties and can lead to major blood loss and prolonged operative times. In recent years, percutaneous instrumentation of non-ankylotic spine fractures has gained popularity, producing similar outcomes to open surgery with shorter operative times and reduced blood loss and hospital length of stay. We describe our experience implementing these techniques in ankylotic spine patients. Methods We retrospectively retrieved from our hospital’s electronic health records all patients treated for thoracolumbar spine fractures between 2008 and 2015 with a diagnosis of ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). Operative and postoperative data, results, and complications were tabulated, and radiographic parameters were evaluated. Results Twenty-four patients with ankylotic spine disease underwent percutaneous augmented instrumentation between 2008 and 2015. The mean age was 76. All patients had at least one comorbidity. The mean number of ankylosed levels was 14. Mean operative time was 131 min. The average postoperative hemoglobin decrease was 1.21 gr/%, with only 4 patients requiring blood transfusion. 45.8% of the patients had postoperative medical complications. One patient (4.2%) had a superficial postoperative infection, and one patient died in hospital. The average hospital length of stay was 14.55 days. All patients retained their preoperative ASIA grades, and 3 improved one grade. All patients united their fractures without losing reduction. Conclusions PMMA-augmented percutaneous instrumentation is an attractive surgical option for this difficult patient subset, especially when compared to other available current alternatives.

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Section: Discussionmentioning

confidence: 99%

Percutaneous, PMMA-augmented, pedicle screw instrumentation of thoracolumbar ankylotic spine fractures

et al. 2021

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“…In this case, the CACAP is large, and the CA is small. For example, the trajectory angulations of percutaneous kyphoplasty and percutaneous pedicle screw fixation are mainly determined by the targeted vertebral pedicle [ 9 ]. In the PETLD technique, the working channel enters the spinal canal through the intervertebral foramen; thus, the trajectory of PETLD requires a longer width skin entry distance from the midline (i.e., a small CACAP) and a suitable CA.…”

Section: Discussionmentioning

confidence: 99%

Angulation error assessment for the trajectory in the anteroposterior and lateral fluoroscopic views during percutaneous endoscopic transforaminal lumbar discectomy

Huang

Hou

et al. 2023

BMC Musculoskelet Disord

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Background Anteroposterior (AP) and lateral fluoroscopies are often used to evaluate the intraoperative location and angulation of the trajectory in percutaneous endoscopic transforaminal lumbar discectomy (PETLD). Although the location of the trajectory shown in fluoroscopy is absolutely accurate, the angulation is not always reliable. This study aimed to evaluate the accuracy of the angle shown in the AP and lateral fluoroscopic views. Methods A technical study was performed to assess the angulation errors of PETLD trajectories shown in AP and lateral fluoroscopic views. After reconstructing a lumbar CT image, a virtual trajectory was placed into the intervertebral foramen with gradient-changing coronal angulations of the cephalad angle plane (CACAP). For each angulation, virtual AP and lateral fluoroscopies were taken, and the cephalad angles (CA) of the trajectory shown in the AP and lateral fluoroscopic views, which indicated the coronal CA and the sagittal CA, respectively, were measured. The angular relationships among the real CA, CACAP, coronal CA, and sagittal CA were further demonstrated with formulae. Results In PETLD, the coronal CA is approximately equal to the real CA, with a small angle difference and percentage error, whereas the sagittal CA shows a rather large angle difference and percentage error. Conclusion The AP view is more reliable than the lateral view in determining the CA of the PETLD trajectory.

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“…El avance de la tecnología en los implantes, permite en la actualidad realizar maniobras de distracción y compresión sobre los tornillos, logrando mejores correcciones en los planos sagital y coronal, y posibilita en algunos casos realizar una "descompresión indirecta" del canal espinal mediante el fenómeno de "ligamentotaxis". 1 La inmovilización en cama en los pacientes politraumatizados es un reconocido factor de mal pronóstico, que aumenta las intercurrencias y la mortalidad. La movilización precoz reduce estas complicaciones.…”

Section: Discussionunclassified

Cirugía mínimamente invasiva en el tratamiento de fracturas tóracolumbares

Guiroy

Landriel

Ciancio

et al. 2020

Rev. Argent. Neuroc.

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Objetivo: Analizar y describir una serie de fracturas tóraco-lumbares traumáticas tratadas con cirugía mínimamente invasiva.Material y métodos: Analizamos una serie de 26 pacientes con fracturas traumáticas tóraco-lumbosacras entre 2010-2017. Las imágenes pre-operatorias fueron clasificadas usando la clasificación AO. Analizamos en forma pre y post operatoria: escala visual analógica, volumen de pérdida sanguínea, duración de la hospitalización, complicaciones, cirugías asociadas en otros órganos, extracción de implantes en el largo plazo, estado neurológico pre y post quirúrgico y mortalidad.Los pacientes con historias clínicas completas, TAC pre-operatoria y un seguimiento mínimo de 12 meses fueron incluidos (18 hombres y 8 mujeres). La edad promedio fue de 28.7 años (21-84 años); seguimiento promedio de 28 meses (13-86 meses). Dieciocho pacientes fueron manejados con instrumentaciones percutáneas, 8 recibieron vertebroplastias, y en 5 casos se realizó además algún gesto de artrodesis.Resultados: La EVA mejoró 7 puntos promedio respecto al pre-operatorio; el promedio de sangrado fue de 40 mL, no observamos ningún caso de empeoramiento neurológico. La duración promedio de la hospitalización fue de 3.9 días. Cuatro enfermos necesitaron alguna cirugía en otro órgano producto de sus politraumatismos.Los tornillos percutáneos fueron removidos en 9 casos luego de la consolidación. Como complicaciones tuvimos: 1 hematoma retroperitoneal autolimitado, una fractura pedicular y una cánula de cementación rota adentro de un pedículo.Conclusión: La cirugía mínimamente invasiva en trauma espinal es una alternativa válida que permite estabilización, movilización precoz y logra buenos resultados en términos de control del dolor con baja tasa de complicaciones.

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Percutaneous Pedicle Screw Stabilization: Surgical Technique, Fracture Reduction, and Review of Current Spine Trauma Applications

Cited by 22 publications

References 28 publications

Percutaneous, PMMA-augmented, pedicle screw instrumentation of thoracolumbar ankylotic spine fractures

Percutaneous, PMMA-augmented, pedicle screw instrumentation of thoracolumbar ankylotic spine fractures

Angulation error assessment for the trajectory in the anteroposterior and lateral fluoroscopic views during percutaneous endoscopic transforaminal lumbar discectomy

Cirugía mínimamente invasiva en el tratamiento de fracturas tóracolumbares

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