Minimally invasive spine surgery in acute dorsolumbar trauma: An experience of 14 cases

This study evaluates the effectiveness of minimally invasive treatment of dorso-lumbar fractures by percutaneous pedicle screw fixation. Patients of acute traumatic single level dorsolumbar and spine fractures requiring surgical intervention were included in this study. Fourteen patients (10 male, 4 female), age range 17-47 years (mean 30.1 ± 7.9 yrs) with dorso-lumbar fractures (D9:1, D12:3, L1:9, L4:1) with TLICS score>4 were studied (Feb 2009-Feb 2011). Total of 60 screws were put of which 2 screws were malpositioned (3.3%). Open conversion was done in two cases (15.3%) due to difficulty in rod positioning. In one case, screw pull out was noted intraoperatively during ligamentotaxis and rod manipulation. No patient had post-operative neurological deterioration. Mean post-operative hospital stay was 3.8 days. Follow-up scans showed satisfactory correction of deformity. Good to excellent outcome was present in 84.6%. We conclude that percutaneous pedicle screws fixation is a safe, reliable, cost effective technique with favorable results in acute polytrauma cases requiring standalone ligamentotaxis. Complex biomechanics/physics of instrumentation, lack of adequate fusion and steep learning curve during initial cases with increased radiation exposure limits its application in all cases.