Use of Minimally Invasive Surgical Techniques in the Management of Thoracolumbar Trauma

Abstract

The application of MIS techniques to spinal trauma is theoretically sound. However, the indications and technology are currently in evolution. Although very limited information is available, the results of current MIS techniques for the management of TL trauma are encouraging.

Pure percutaneous pedicle screw fixation without arthrodesis of 32 thoraco-lumbar fractures: clinical and radiological outcome with 36-month follow-up

“…Differently, the surgical strategy of treatment in terms of choice of both surgical approach and length of the fixation system is still controversial [2,3].…”

“…As standard open surgery and minimally invasive spine surgery (MISS) have been often compared in the recent literature, it is quite evident that the trend is currently moving toward MISS since this technique provides lower amount of blood loss as well as lower rates of infections related to surgery [4], reduces muscle trauma, decreases operative site pain and for the above mentioned reasons contributes in shortening hospitalization [2,5]. Moreover, both techniques (MISS and open surgery) seem to provide the same results in terms of both correcting spine kyphosis angle and restoring vertebral body height [4].…”

Percutaneous pedicle screw fixation in polytrauma patients

“…In trauma patients conventional open approaches are generally related to significant morbidity due to increased infection rate, high blood loss and approach related morbidity (muscle morbidity as denervation, revascularization damage, increased intramuscular pressures, etc. [21][22][23]). This increased morbidity associated to the difficult hemodynamic management and the possible ventilatory/perfusion mismatch in the first 48 h in polytrauma patients led, generally, to delay surgery.…”

“…This increased morbidity associated to the difficult hemodynamic management and the possible ventilatory/perfusion mismatch in the first 48 h in polytrauma patients led, generally, to delay surgery. Percutaneous fixation is beginning to be considered as a temporary solution to these complications [23]. Early percutaneous fixation, also in unstable amyelic fractures, provides the possibility to obtain a temporary mechanical stability sufficient to enhance mobilization of the patients improving so pulmonary/respiratory care and nursing.…”

“…Early percutaneous fixation, also in unstable amyelic fractures, provides the possibility to obtain a temporary mechanical stability sufficient to enhance mobilization of the patients improving so pulmonary/respiratory care and nursing. Percutaneous screw fixation is characterized by faster surgical time, decreased blood loss and muscle morbidity and so represents a valid alternative treatment in the polytrauma population, which is characterized by transient malnutrition, immune changes and skin colonization [23]. Despite the proven advantages of this surgical technique consensus about its use in polytrauma patients in the spinal community is lacking.…”