Posterior Surgical Management of Thoracic and Lumbar Fractures

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.