Transcript PROSPECTIVE ANALYSIS OF GRAFT OPTIONS FOR ANTERIOR LUMBAR

OUTCOMES FOLLOWING PERCUTANEOUS PEDICLE FIXATION
FOR SPINE FRACTURE.
Ralph Mobbs
Prince of Wales Hospital / NeuroSpineClinic
University of New South Wales
CONCLUSIONS
INTRODUCTION
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.
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.
Case Examples
CASE 2: 16M / Motor Bike – T12# - ASIA_A – sitting up day 1 postop.
METHODS
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:
1. Chance fracture: 3 patients.
2. Pathological fracture: 6 patients (5 tumour, 1 infection).
3. Thoracolumbar burst or flexion/distraction injury: 5 patients.
CASE 3: 60F / Fall – L3# & multiple injuries - screws removed 9/12 postop.
CASE 1: 52F / IVDU HIV+
Hep C+ – L1/2
osteomyelitis with
pathological fracture.
REFERENCES
RESULTS
1. 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.
2. Beringer, W., et al., Percutaneous pedicle screw instrumentation for temporary
internal bracing of nondisplaced bony Chance fractures. J Spinal Disord Tech, 2007.
3. Mobbs RJ, Sivabalan P, Li J. Technique, challenges and indications for percutaneous
pedicle screw fixation. J Clin Neurosci. 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
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.
RESEARCH POSTER PRESENTATION DESIGN © 2011
www.PosterPresentation
s.com
e [email protected]
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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.
Sydney, 2012