Advertisement

Spine Surgery pp 281-287 | Cite as

Posterior Surgical Management of Thoracic and Lumbar Fractures

  • Yann Philippe CharlesEmail author
Chapter

Abstract

Unstable thoracolumbar fractures and trauma leading to severe kyphosis are usually treated surgically. There is no clear consensus whether open or percutaneous instrumentation should be preferred, and the necessity of grafting remains debated. Currently, there is an increasing trend towards Minimally Invasive Surgery (MIS), since percutaneous instrumentation decreases the risk for bleeding and infection during the perioperative period, and it shortens the length of hospitalization. Clinical trials comparing open and percutaneous techniques indicate that MIS leads to lower pain and disability scores at short-term, whereas clinical results are similar after 6 months. There is only little evidence on long-term outcomes after posterior percutaneous instrumentation. However, clinical results and sagittal alignment are maintained effectively with MIS if the right surgical strategy has been chosen according to the fracture type, the patient’s age and general health status.

References

  1. 1.
    Scheer JK, Bakhsheshian J, Fakurnejad S, Oh T, Dahdaleh NS, Smith ZA. Evidence-based medicine of traumatic thoracolumbar burst fractures: a systematic review of operative management across 20 years. Global Spine J. 2015;5(1):73–82.CrossRefGoogle Scholar
  2. 2.
    Court C, Vincent C. Percutaneous fixation of thoracolumbar fractures: current concepts. Orthop Traumatol Surg Res. 2012;98:900–9.CrossRefGoogle Scholar
  3. 3.
    Lee JK, Jang JW, Kim TW, Kim TS, Kim SH, Moon SJ. Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures: is it effective? Comparative study with open short-segment pedicle screw fixation with posterolateral fusion. Acta Neurochir. 2013;155(12):2305–12.CrossRefGoogle Scholar
  4. 4.
    Vanek P, Bradac O, Konopkova R, Lacy P, Lacman J, Benes V. Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up. J Neurosurg Spine. 2014;20(2):150–6.CrossRefGoogle Scholar
  5. 5.
    Zairi F, Aboukais R, Marinho P, Allaoui M, Assaker R. Minimally invasive percutaneous stabilization plus balloon kyphoplasty for the treatment of type A thoraco lumbar spine fractures: minimum 4 year's follow-up. J Neurosurg Sci. 2014;58(3):169–75.PubMedGoogle Scholar
  6. 6.
    Charles YP, Walter A, Schuller S, Steib JP. Temporary percutaneous instrumentation and selective anterior fusion for thoracolumbar fractures. Spine (Phila Pa 1976). 2017;42(9):E523–31.CrossRefGoogle Scholar
  7. 7.
    Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, Reinhold M, Aarabi B, Kandziora F, Chapman J, Shanmuganathan R, Fehlings M, Vialle L, AOSpine Spinal Cord Injury & Trauma Knowledge Forum. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):2028–37.CrossRefGoogle Scholar
  8. 8.
    Weiß T, Hauck S, Bühren V, Gonschorek O. Repositioning options with percutaneous dorsal stabilization. For burst fractures of the thoracolumbar junction. Unfallchirurg. 2014;117(5):428–36.CrossRefGoogle Scholar
  9. 9.
    Charles YP, Walter A, Schuller S, Aldakheel D, Steib JP. Thoracolumbar fracture reduction by percutaneous in situ contouring. Eur Spine J. 2012;21(11):2214–21.CrossRefGoogle Scholar
  10. 10.
    Fuentes S, Blondel B, Metellus P, Gaudart J, Adetchessi T, Dufour H. Percutaneous kyphoplasty and pedicle screw fixation for the management of thoraco-lumbar burst fractures. Eur Spine J. 2010;19(8):1281–7.CrossRefGoogle Scholar
  11. 11.
    Ntilikina Y, Bahlau D, Garnon J, Schuller S, Walter A, Schaeffer M, Steib JP, Charles YP. Open versus percutaneous instrumentation in thoracolumbar fractures: magnetic resonance imaging comparison of paravertebral muscles after implant removal. J Neurosurg Spine. 2017;27(2):235–41.CrossRefGoogle Scholar
  12. 12.
    Loriaut P, Mercy G, Moreau PE, Sariali E, Boyer P, Dallaudière B, Pascal-Moussellard H. Initial disc structural preservation in type A1 and A3 thoracolumbar fractures. Orthop Traumatol Surg Res. 2015;101(7):833–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Service de Chirurgie du RachisHôpitaux Universitaires de StrasbourgStrasbourgFrance

Personalised recommendations