Thurs., 10/16/08 Spine, Paper #4, 2:48 pm OTA-2008
Closed Reduction and Percutaneous Pedicle Screw Fixation (CRPF) of Thoracolumbar Fractures with and without Fusion: Safety and Outcome
Tony Y. Tannoury, MD (c,e-DePuy Spine); Jeremy Macko, MA, BA (n);
Boston University, Boston, Massachusetts, USA
Purpose: This is a retrospective review of case series analyzing the validity and the safety of CRPF of thoracolumbar fractures.
Hypothesis: Closed reduction and percutaneous pedicle screw fixation is a valid and safe tool for the management of spinal trauma patients.
Methods: We conducted a retrospective review of the first 38 patients (259 screws) with unstable burst fractures admitted to a Level 1 trauma center who were treated with CRPF. Medical records and radiographic studies were reviewed for procedure-related complications (infection, vascular injuries, iatrogenic neurologic injuries, and accuracy of screw placement) and the ability to re-establish and maintain spinal stability and alignment. Patients with incomplete spinal cord injury or deteriorating neurologic examination with spinal cord compression were managed with anterior corpectomy and posterior percutaneous pedicle screw fixation.
Results: All patients underwent preoperative CT scan as part of their trauma workup. 25 patients (170 screws) underwent postoperative CT scans, mostly for other organ injuries. Screw placement accuracy and spinal alignment were established based upon the CT scan (when available) and postoperative radiographs. In the CT group, all screws where found to be fully contained within the pedicle wall except for 10 breaches (5 critical breaches [>2 mm] and 5 minor breaches (<2 mm]). One patient developed a diffuse postoperative left leg weakness and was found to have 2 critical breaches with cord compression at the T9 level. The patient returned to the operating room and, following adjustment of the breached screws, had a full neurologic recovery. In the radiograph-based analysis group, no neurologic injury and no suspicious breaches were found. No infections were noted, but one ankylosing spondylitis patient who presented with T9 complete spinal cord injury and severe thoracic kyphosis developed skin breakdown over three screw heads. All patients were stabilized with short segment constructs without any mechanical failure. Total average kyphosis (thoracic and lumbar) was corrected from 16.4° to 1.8°.
Conclusion: CRPF is a safe and effective method for managing unstable spinal column injuries that offers the added benefit of being less invasive than the current standard of care (spinal fusion). This is particularly significant when considering the complexities and vulnerabilities of multisystem-injured patients.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant