Abstract
Purpose of the study: This study was conducted to assess short- and mid-term radiographic outcome of percutaneous posterior osteosynthesis (Sextant®)of thoracolumbar spine fractures and to identify indications and complications.
Material and methods: The Sextant® material was used for 14 patients with a lumbar spine or low thoracic spine fracture. Mean patient age was 40 years (range 19–84). Outcome was reviewed retrospectively. Osteosynthesis was performed for 11 fractures Mager 1 A3, 2 B2, 1 C1 with no neurological deficit. A complementary graft and anterior decompression were used 11 times (9 fibular, 1 posterior crest + rib, 1 cage). The pre- and postoperative and 3 month ART were noted. The position of the implants was assessed on the postoperative CT.
Results: Mean follow-up was 9.2 months (range 2–16). On average, ostheosynthesis was performed 15 days after trauma (range 1–90 days). There were no neurological or infectious complications. Sutures had to be resected in two cases due to cutaneous suffering. Nine patients wore a corset for three months. The absolute ART score improved from 18 preoperatively to 7 postoperatively and was noted at 14 at three months. Seven patients required heterologous blood transfusion after the anterior approach. Three screws (5.3%) were ectopic but without consequence.
Discussion: Indications for percutaneous osteosynthesis include spinal fractures without neurological complications with sagittal deformation for which an anterior approach is planned initially for mechanical reasons. An isolated anterior approach is possible in this type of fracture; nevertheless, percutaneous posterior osteosynthesis enables emergency reduction and fixation of the fracture, a simplified secondary minimal anterior approach for release, and bone grafting without anterior instrumentation. Three patients did nor require complementary anterior stabilization as the percutaneous oseosynthesis played the role of «internal fixation». The advantages of percuteneous osteosynthesis are the absence of bleeding and damage to the paravertebral muscles which limits morbidity, particularly infection. This technique can be performed in the emergency setting, especially for multiple trauma victims. The drawbacks of percutaneous osteosynthesis are the impossibility of performing a posterior fusion and release the spinal canal. The loss of correction observed were probably related to the type of graft (fibular). Use of a cage should limit graft impaction and loss of correction.
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