Abstract
Background
Minimally invasive surgery is an alternative therapeutic option for treating unstable spinal pathologies to reduce approach-related morbidity inherent to conventional open surgery.
Objective
To compare the safety and therapeutic efficacy of percutaneous fixation to that of open posterior spinal stabilisation for instabilities of the thoraolumbar spine.
Study Design
Comparison study of prospective historical cohort versus retrospective historical control at a tertiary care centre.
Methods
Patients who underwent open or percutaneous posterior fixation for thoracic-lumbar instabilities secondary to metastasis, infection and acute trauma were included. Minimally access non traumatic instrumentation system (MANTIS) was used for percutaneous stabilisation.
Outcome Measures
The differences in surgery-related parameters including operative time, blood loss, radiation exposure time, analgesia requirement, screw related problems and length of hospitalisation between the groups were analyzed.
Results
There were a total of 50 patients with 25 in each group. There were no significant differences concerning age, sex, ASA, pathology causing instability, level and number of segments stabilised between the groups. There were significant differences between the MANTIS and open group in terms of blood loss (492 versus 925 ml, p<0.0001), post-op analgesia requirement (33 versus 45 mg/day of morphine, p<0.0004) and length of hospital stay for trauma sub-group of patients (6.2 versus 9.6 days, p< 0.0008). Average operative time of the MANTIS group was 190.2 minutes, not significantly longer to that of the conventional open group (183.84 minutes, p>0.05) Open group patients had less radiation exposure (average of 0.6 minutes) compared to MANTIS cohort (3.1 minutes). There were 2 patients with screw misplacements comprising one from each group that needing revision.
Conclusion
Percutaneous spinal stabilisation using mini-invasive system is a good surgical therapeutic choice in thoracic-lumbar instabilities. It has the advantage of less trauma, quick recovery and shortened hospital stay with accuracy of screw placement as similar to those reported for other techniques. Indications and limitations of this technique must be carefully identified.
Interest Statement
There was no commercial support or funding of any sort.
