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Minimally invasive surgery (MIS) for reduction and stabilization of single level burst fractures of the thoracolumbar and lumbar spine
EANS Academy. Gabrovsky N. Sep 27, 2019; 276057; EP02111
Prof. Nikolay Gabrovsky
Prof. Nikolay Gabrovsky

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Abstract
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Introduction: A number of techniques are feasible when dealing with burst fractures of the spine. Minimally invasive techniques for spinal fixation are becoming very popular in the last few years to reduce the approach-related morbidity associated with conventional techniques. We present our experience regarding the effectiveness, clinical and radiological outcome after minimally invasive posterior transpedicular stabilization for burst (A3) fractures of the thoracolumbar and lumbar spine.
Materials and methods: For the period 04.2013-12.2018 twenty-nine patients presenting with an A3 fracture were operated in the Department of Neurosurgery in University Hospital Pirogov using percutaneous posterior transpedicular technique for reduction, indirect decompression and fixation. Clinical and functional outcome were evaluated by Visual Analog Scale (VAS), Oswestry Disability Index (ODI).
Results: The constructs comprised vertebral levels between T11 to L5. Short segment fixation with an index level screw was preferred in 19 cases, short segment fixation with PMMA augmentation of the fractured vertebra in 2 cases and long segment fixation in 8 cases.
Average operative blood loss was 80 mL (50-150), operation time from 60 to 120 min. Satisfactory reduction of the spinal deformity and decompression was achieved. Pain assessment showed significant improvement. The mean hospital stay was 5 days. No significant loss of correction was observed during the follow-up. No significant difference was identified between short segment fixation including the fractured vertebra and long segment fixation regarding radiological and functional outcome.
Conclusion: Percutaneous pedicle screw fixation for A3 thoracolumbar and lumbar spinal fractures is a reliable and safe procedure. MIS techniques achieve the main goals of the surgical treatment for spine trauma - decompression, realignment and stabilization.
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