OUTCOMES FOLLOWING PERCUTANEOUS PEDICLE FIXATION FOR SPINE FRACTURE.

1. OUTCOMES FOLLOWING PERCUTANEOUS PEDICLE FIXATION FOR SPINE FRACTURE. REFERENCES Percutaneous fixation techniques for stabilization of the spinal segment following spinal trauma has potential advantages in selected patients. The minimized collateral soft tissue damage with the MIS technique results in reduced time to mobilize with less postoperative pain and a lower complication rate (1,2,3). In patients requiring stabilization of a fracture, without the need for multi-segmental posterior fusion, the percutaneous technique has many potential advantages (2). Removal of the pedicle screws following union of the fracture may return functional spinal units back to mobility and restore the spinal biomechanics without the requirement of a multilevel fusion (1). In patients with cancer and a pathological fracture, stabilization may benefit with a rapid return of mobility in a patient group with a significantly reduced longevity. METHODS CONCLUSIONS Percutaneous pedicle fixation and stabilization of the injured spinal segment is a successful management strategy for spinal trauma in selected patients, such as chance#, various thoraco-lumbar# and pathological fractures. Additional research is required to determine the advantages of various fracture patterns and types, however an assessment of this prospective cohort and a review of other case series confirms there are definite benefits of percutaneous techniques for spinal trauma. Additional advantages include: the removal of fixation hardware to restore movement at non-fused segments, reduced complication rates of surgery, and early mobilization. INTRODUCTION Ni, W.F., et al., Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. J Spinal Disord Tech, 2010. 23(8): p. 530-7. Beringer, W., et al., Percutaneous pedicle screw instrumentation for temporary internal bracing of nondisplaced bony Chance fractures. J Spinal Disord Tech, 2007. Mobbs RJ, Sivabalan P, Li J. Technique, challenges and indications for percutaneous pedicle screw fixation. J ClinNeurosci. 2011 Jun;18(6):741-9. Epub 2011 Apr 21. CONTACT & DISCLOSURE Dr Ralph Mobbs MD MS FRACS Prince of Wales Private Hospital NeuroSpineClinic www.neurospineclinic.com.au e contact@sydneyspineclinic.com.au p +612 9650 4766 f +612 9650 4943 Prince of Wales Hospital / NeuroSpineClinic University of New South Wales Ralph Mobbs The outcomes of 14 patients, aged 16 to 87, were prospectively assessed. The surgeries were performed between March, 2009 to November, 2011 by the author. 6 patients were fixed with short segmentation while the remaining 8 fixed with long segmentation. Percutaneous systems used include: MANTIS (Stryker, USA) and SERENGETI (K2M, Leesburg USA). The indications for inclusion in the study were: Chance fracture: 3 patients. Pathological fracture: 6 patients (5 tumour, 1 infection). Thoracolumbar burst or flexion/distraction injury: 5 patients. Case Examples CASE 2: 16M / Motor Bike – T12# - ASIA_A – sitting up day 1 postop. CASE 3: 60F / Fall – L3# & multiple injuries - screws removed 9/12 postop. Path# L1/L2 CASE 1: 52F / IVDU HIV+ Hep C+ – L1/2 osteomyelitis with pathological fracture. RESULTS Major shareholding Medtronic Major shareholding in Johnson / Johnson (Depuy) Minor shareholding in HealthScope Consultancy Agreements / Design / Development: Kasios Biomaterials , Spine Surgical Innovation (SSI), K2M, Stryker Spine, Cerapedics. Travel / Training: Synthes, Stryker, K2M, LifeHealthCare, Cerapedics. All patients were mobilized within 24 hours of surgery. Complications of surgery included 2 superficial infections treated with antibiotics. No patients had worsening of neurological function. Of 96 percutaneously inserted pedicle screws, 2 screws had a medial pedicle breach of less than 3mm. 4 patients have had removal of their fixation hardware to restore motion in non-fused segments. Sydney, 2012