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.
Keywords
minimal invasive spine - pedicle screws - thoracic fracture - lumbar fracture - spine trauma
