311. PERCUTANEOUS INSTRUMENTATION OF THORACOLUMBAR FRACTURES: PRELIMINARY RESULTS AT TEN MONTHS IN A PROSPECTIVE CONSECUTIVE SERIES OF TWENTY PATIENTS

Abstract

Purpose of the study: We present the clinical and radiologic results of a prospective series of 20 patients who had percutaneous osteosynthesis of the thoracolumbar spine using a longitudinal system with monoaxial screws.

Material and methods: Twenty patients, 12 women, were treated from February 2008 to February 2009. Mean age was 44 years (15–61 years). Fractures were from T4 to L5, five patients had two levels fractured. There were 18 Magerl A and two type B. None of the patients had neurological problems. The reduction was achieved with a postural method and instrumentation with monoaxial screws using the percutaneous longitudinal method. Two levels were instrumented for 12 patients, three levels for three and five levels for four. Vertebroplasty was associated in nine patients. Pain (VAS), vertebral kyphosis (VK), regional angle (RA) were assessed pre-, postoperatively and at last follow-up. Operative time, blood loss, and duration of hospital stay were noted. Pedicle implantations were controlled on the scanner.

Results: Mean follow-up was ten months (3–19 months). In the preoperative phase, the VAS was 7/10, VK 17 (8–26), RA 16.6 (4–30). Postoperatively VAS was 4/10), VK 8 (4–15), RA 10.4 (−3 to 27). AT last follow-up VK was 8.5 and RA 12. Mean operative time was 90 minutes (40–180). On the postoperative scan, 23 of the 106 screws implanted had an extraosseous position (21%) including seven cranial screws. None of the patients developed a neurological deficit postoperatively. The first rise from bed was on day 1 in 14 patients. Mean duration of hospital stay was eight days (6–35).

Discussion: This reduction method provides a gain in VK (−9), a value between orthopaedic treatment (−8 gain) and surgical treatment as reported at the Sofcot in 1995 (−11.1 gain). The reduction was maintained well without loss at last follow-up.

Conclusion: This technique allows assembly of more or less long rigid configurations depending on the injury levels, with satisfactory reduction which is sustained over time. Blood loss is zero with little pain in the postoperative period.