Posterior Percutaneous Techniques for Thoracolumbar Trauma

Minimally invasive surgical techniques have expanded from their initial indications for the elective treatment of degenerative conditions to include their application in the setting of trauma. Percutaneous pedicle screw placement offers an option in the treatment of a variety of thoracolumbar fractures in neurologically intact patients. Screws can be used for the management of unstable burst fractures or as an “internal splint” for patients in whom bracing of a stable fracture may be contraindicated. In addition, they can be used for treatment of bony Chance fractures, allowing fracture healing without fusion. Percutaneous screws can be applied in a “damage control” setting as temporary stabilization in patients with multiple traumatic injuries who might not be physiologically able to tolerate a definitive open procedure early in their hospitalization. Finally, this technique can be applied to patients with ankylosing spinal disorders for stabilization without fusion until bony healing occurs. The technique for posterior pedicle screw placement and reduction maneuvers is described. Posterior minimally invasive screw placement is a safe, effective, viable option for stabilization of thoracolumbar fractures in a variety of settings.