Dual, Minimally Invasive Fixation in Acute, Double, Thoracic Spine Fracture
25 January 2012 (online)
We report on a dual percutaneous fixation in 2 patients with a double thoracic spine fracture. The advantages and limitations of this new approach for treating traumatic spinal fractures are reviewed.
A 67-year-old male was admitted following a fall from a height of 3 m. A neurological examination revealed sub-T11 motor and sensory paraparesis. There were a T6 vertical body and bi-articular fracture and a T11 vertebral burst fracture with > 75% posterior wall damage. A 40-year-old male was admitted after a suicide attempt. A neurological examination revealed sub-T11 paraplegia. There were a T7 vertebral body fracture with intact posterior wall and a T11 burst fracture with > 75% posterior wall damage.
The same technique was used in both cases. 2 minimally invasive percutaneous fixations of the 2 fractures were performed. In a third step, we performed a T10-T12 open laminectomy. This technique helped to limit blood loss and avoid an over-long fixation. Pedicle screw targeting was optimal. 16 months later, the neurological status was normal in patient 1 and there was neurological improvement in patient 2. No secondary segmental kyphotic deformities appeared.
Percutaneous fixation enables the treatment of an acute thoracic spine fracture. With appropriate presurgical planning, this technique can be applied to all thoracic vertebrae. Spinal cord injuries justify the use of laminectomy together with percutaneous fixation, in order to limit erector muscle injury and blood loss.
- 1 Acosta Jr FL, Aryan HE, Taylor WR et al. Kyphoplasty-augmented short-segment pedicle screw fixation of traumatic lumbar burst fractures: initial clinical experience and literature review. Neurosurg Focus 2005; 15; 18 (03) e9
- 2 Acosta Jr FL, Thompson TL, Campell S et al. Use of intraoperative isocentric C-arm 3-D fluoroscopy for sextant percutaneous pedicle screw placement: Case report and review of the literature. Spine J 2005; 5: 339-343
- 3 Beringer W, Potts E, Khairi S et al. Percutaneous pedicle screw instrumentation for temporary internal bracing of nondisplaced bony Chance fractures. J Spinal Disord Tech 2007; 20: 242-247
- 4 Fuentes S, Metellus P, Fondop J et al. Percutaneous pedicle screw fixation and kyphoplasty for management of thoracolumbar burst fractures. Neurochirurgie 2007; 53: 272-276
- 5 Kim DY, Lee SH, Chung SK et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: Percutaneous versus open pedicle screw fixation. Spine 2005; 30: 123-129
- 6 Levine DS, Dugas JR, Tarantino SJ et al. Chance fracture after pedicle screw fixation. A case report. Spine 1998; 23: 382-385 discussion 386
- 7 Maciejczak A, Barnas P, Dudziak P et al. Posterior keyhole corporectomy with percutaneous pedicle screw stabilization in the surgical management of lumbar burst fractures. Neurosurgery 2007; 60 (Suppl. 02) 232-241 discussion 241–242
- 8 Rampersaud YR, Annand N, Dekutoski MB. Use of minimally invasive surgical techniques in the management of thoracolumbar trauma: current concepts. Spine 2006; 31 (11 Suppl) S96-S102 discussion S104
- 9 Ringel F, Stoffel M, Stüer C et al. Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine. Neurosurgery. 2006; 59 (Suppl. 02) ONS361-ONS366 discussion ONS366–ONS367
- 10 Yue JJ, Sossan A, Selgrapht C et al. The treatment of unstable thoracic spine fractures with transpedicular screw instrumentation: a 3 year consecutive series. Spine 2002; 27: 2782-2787