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DOI: 10.1055/s-0032-1330123
Temporary Percutaneous Pedicle Screw Fixation for Treatment of Thoracolumbar Injuries in Young Adults
Publikationsverlauf
03. Dezember 2010
02. März 2012
Publikationsdatum:
04. Januar 2013 (online)
![](https://www.thieme-connect.de/media/jnlsa/201301/lookinside/thumbnails/10.1055-s-0032-1330123-1.jpg)
Abstract
Objective Bone-only injuries of the spine, including Chance fractures, are commonly managed nonoperatively. However, selected patients may benefit from surgical stabilization. In this report, the authors describe a method of temporary internal fixation with percutaneous pedicle screws for patients with intractable pain and thoracolumbar fractures.
Methods We reviewed the medical records and imaging studies of three patients 17 to 21 years old with thoracolumbar fractures that were treated with temporary internal fixation. The patients had bone-only injuries without a major deformity. Additionally, they had severe pain that was uncontrolled with parenteral pain medications and prevented mobilization with traditional external bracing. For fixation, pedicle screws were placed percutaneously in the level above and below the fracture. No arthrodesis was performed. After 6 months, fracture healing was evaluated radiographically. Once confirmed, the instrumentation was removed. Outcomes examined include length of stay, pain control, time to ambulation, and fracture healing.
Results Three patients were included in the review, ages 17 to 21 (mean 18.7) years. Two patients had classic Chance fractures, and the third had bilateral pars fractures with a compression fracture at the same level. All patients had severe pain despite bracing. Postoperatively, all patients had significant pain reduction that facilitated rapid mobilization. At 6 months after surgery, fracture healing was verified with radiographic imaging and the instrumentation was removed. There were no complications.
Conclusions Temporary internal bracing of bone-only thoracolumbar fractures in young adults is a safe and effective treatment strategy in selected patients. This procedure provides rapid pain control and early mobilization without sacrificing any spinal motion segments.
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References
- 1 Clark P, Letts M. Trauma to the thoracic and lumbar spine in the adolescent. Can J Surg 2001; 44 (5) 337-345
- 2 Slotkin JR, Lu Y, Wood KB. Thoracolumbar spinal trauma in children. Neurosurg Clin N Am 2007; 18 (4) 621-630
- 3 Akbarnia BA. Pediatric spine fractures. Orthop Clin North Am 1999; 30 (3) 521-536 , x x.
- 4 Dogan S, Safavi-Abbasi S, Theodore N , et al. Thoracolumbar and sacral spinal injuries in children and adolescents: a review of 89 cases. J Neurosurg 2007; 106 (6, Suppl) 426-433
- 5 Chow GH, Nelson BJ, Gebhard JS, Brugman JL, Brown CW, Donaldson DH. Functional outcome of thoracolumbar burst fractures managed with hyperextension casting or bracing and early mobilization. Spine 1996; 21 (18) 2170-2175
- 6 Horal J, Nachemson A, Scheller S. Clinical and radiological long term follow-up of ventebral fractures in children. Acta Orthop Scand 1972; 43 (6) 491-503
- 7 Hitchon PW, Torner JC. Recumbency in thoracolumbar fractures. Neurosurg Clin N Am 1997; 8 (4) 509-517
- 8 Gallagher DJ, Heinrich SD. Pediatric chance fracture. J Orthop Trauma 1990; 4 (2) 183-187
- 9 Weninger P, Schultz A, Hertz H. Conservative management of thoracolumbar and lumbar spine compression and burst fractures: functional and radiographic outcomes in 136 cases treated by closed reduction and casting. Arch Orthop Trauma Surg 2009; 129 (2) 207-219
- 10 Parisini P, Di Silvestre M, Greggi T. Treatment of spinal fractures in children and adolescents: long-term results in 44 patients. Spine 2002; 27 (18) 1989-1994
- 11 Lee JY, Vaccaro AR, Lim MR , et al. Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. J Orthop Sci 2005; 10 (6) 671-675
- 12 Papavasiliou A, Stanton J, Sinha P, Forder J, Skyrme A. The complexity of seat belt injuries including spinal injury in the pediatric population: a case report of a 6-year-old boy and the literature review. Eur J Emerg Med 2007; 14 (3) 180-183
- 13 Beaunoyer M, St-Vil D, Lallier M, Blanchard H. Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision. J Pediatr Surg 2001; 36 (5) 760-762
- 14 Subotic U, Holland-Cunz S, Bardenheuer M, Loff S, Wessel LM. Chance fracture—a rare injury in pediatric patients?. Eur J Pediatr Surg 2007; 17 (3) 207-209
- 15 Chance GQ. Note on a type of flexion fracture of the spine. Br J Radiol 1948; 21 (249) 452
- 16 Foley KT, Gupta SK, Justis JR, Sherman MC. Percutaneous pedicle screw fixation of the lumbar spine. Neurosurg Focus 2001; 10 (4) E10
- 17 Palmisani M, Gasbarrini A, Brodano GB , et al. Minimally invasive percutaneous fixation in the treatment of thoracic and lumbar spine fractures. Eur Spine J 2009; 18 (Suppl. 01) 71-74
- 18 Rampersaud YR, Annand N, Dekutoski MB. Use of minimally invasive surgical techniques in the management of thoracolumbar trauma: current concepts. Spine(Phila Pa 1976) 06; 31 (11, Suppl) S96-S102 , discussion S104
- 19 Baaj AA, Uribe JS, Vale FL. Open reduction and internal fixation of a lumbar Chance fracture in a child using Songer cable and lamina plates. J Neurosurg Pediatr 2009; 3 (2) 129-131
- 20 Wang ST, Ma HL, Liu CL, Yu WK, Chang MC, Chen TH. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study. Spine 2006; 31 (23) 2646-2652 , discussion 2653
- 21 Sanderson PL, Fraser RD, Hall DJ, Cain CM, Osti OL, Potter GR. Short segment fixation of thoracolumbar burst fractures without fusion. Eur Spine J 1999; 8 (6) 495-500
- 22 Dai LY, Jiang LS, Jiang SD. Posterior short-segment fixation with or without fusion for thoracolumbar burst fractures. a five to seven-year prospective randomized study. J Bone Joint Surg Am 2009; 91 (5) 1033-1041
- 23 Beringer W, Potts E, Khairi S, Mobasser JP. Percutaneous pedicle screw instrumentation for temporary internal bracing of nondisplaced bony Chance fractures. J Spinal Disord Tech 2007; 20 (3) 242-247