In Thoracolumbar Fractures Treated By MISS in Neurologically-intact Pateints Is Decompression Necessary
Presented at SMISS Annual Forum 2014
By Mohammad Alfawareh MD
Disclosures: Mohammad Alfawareh MD None
Thoracolumbar spines are common site for different spine pathology and fractures, some fracture has retropulsed fragments in the canal, without neurological compromise, usually fixed by pedicle screw which is common method for spine fixation and fusion, MISS pedicle screw placement was considered save, less traumatic method of fixation. When we have retropulsed fragment many surgeon choose to go for open fixation to facilitate decompression of the canal, this is may be a valid option when patients are have neurologic deficit, but when intact neurologically decision to go for open versus MISS is challenging with fragment in the canal.
Present our series of thoracolumbar spine burst fractures, with fragment in the canal was treated with MISS fixation with no decompression
A retrospective analysis of patients with thoracolumbar spine fractures, inclusion criteria were fractures of the thoracic or lumbar spines between T10 and L4, with retropulsed fragment in the canal, intact neurological exam apart from mild numbness in the lower limbs, treated by MISS, no canal decompression was attempted. Canal dimensions were measured using initial post-trauma CT, we measured canal dimensions at the fractured vertebra, one vertebra above and one below, compared to the same levels at 2 years postoperative scan. Fragment dimensions also were measured using the same scans.
There were 20 cases meet our inclusion criteria, fixed my MIS operations, 13 males and 7 females, mean age was 46.6 years, there were 4.5 fusion levels, about 110 screws were inserted.
Average canal stenosis was 65%, at the first post injury scan, was improved by 25% by fixation in the post-operative scan, and by 60% at the final follow up scan, last canal dimensions were up to 85% of the original canal dimensions as compared with the adjacent levels. Fragment shoed complete healing at the final follow up, sized was decrease by 75%. Patient’s symptoms were improved as fracture healed.
In thoracolumbar burst fracture, with fragment in the canal, with intact neurological symptoms, operated by MIS technique, fragment showed complete healing and resorption t 2 years follow up, with improvement of canal dimensions and approaching normal although the canal shape may be deformed.