Temporary Monosegmental Fixation Using Multiaxial Percutaneous Pedicle Screws for Surgical Management of Bony Flexion-Distraction Injuries of the Thoracolumbar Spine: A Technical Note
Introduction: The efficacy of minimally invasive surgeries for thoracolumbar flexion-distraction injuries (FDIs) has been reported, but those surgeries were monosegmental fusion surgeries of two adjacent vertebrae with bone grafts or temporary fixations using percutaneous pedicle screws (PPSs) that...
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| Format: | Article |
| Language: | English |
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The Japanese Society for Spine Surgery and Related Research
2022-11-01
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| Series: | Spine Surgery and Related Research |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/ssrr/6/6/6_2022-0005/_pdf/-char/en |
| _version_ | 1811177820345335808 |
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| author | Kazuya Kitamura Kentaro Fukuda Yuichiro Takahashi Takeshi Fujii Masahiro Ozaki |
| author_facet | Kazuya Kitamura Kentaro Fukuda Yuichiro Takahashi Takeshi Fujii Masahiro Ozaki |
| author_sort | Kazuya Kitamura |
| collection | DOAJ |
| description | Introduction: The efficacy of minimally invasive surgeries for thoracolumbar flexion-distraction injuries (FDIs) has been reported, but those surgeries were monosegmental fusion surgeries of two adjacent vertebrae with bone grafts or temporary fixations using percutaneous pedicle screws (PPSs) that were at least bisegmental. Our idea was to fuse the fracture itself, not to fuse the fractured vertebra with an adjacent vertebra or to stabilize the fractured vertebra by bridging rostrally/caudally adjacent intact vertebrae, specifically when the displacement is minimal. This study aimed to present the surgical techniques of reduction and temporary monosegmental fixation of neurologically intact thoracolumbar bony FDIs using multiaxial PPSs, which can minimize the surgical invasiveness and preserve all motion segments, as well as report three cases treated with this procedure.
Technical Note: When the fracture extended from the vertebral body to the spinous process at the same level, screws were placed into the fractured vertebra rostrally to the fracture along the rostral endplate, and the caudally adjacent vertebra was instrumented beyond the fracture line. When the fracture extended from the vertebral body to the spinous process of the rostrally adjacent vertebra, screws were placed into the fractured vertebra caudally to the fracture line, and the rostrally adjacent vertebra was instrumented. The kyphotic deformity was reduced through ligamentotaxis by using MPPSs in the rostral vertebra as rigid joysticks to apply direct buttress leverage to the rostral endplate. Intraoperative blood loss was minimal. The correction of kyphotic deformity and its durability were acceptable, and the segmental range of motion of the two affected vertebrae from flexion to extension was maintained after implant removal.
Conclusions: This surgery can act as the least-invasive option for the management of thoracolumbar bony FDIs to allow early ambulation without external bracing and to preserve all the motion segments. |
| first_indexed | 2024-04-11T06:07:50Z |
| format | Article |
| id | doaj.art-93133618fb0d47a882d405cf16aaa184 |
| institution | Directory Open Access Journal |
| issn | 2432-261X |
| language | English |
| last_indexed | 2024-04-11T06:07:50Z |
| publishDate | 2022-11-01 |
| publisher | The Japanese Society for Spine Surgery and Related Research |
| record_format | Article |
| series | Spine Surgery and Related Research |
| spelling | doaj.art-93133618fb0d47a882d405cf16aaa1842022-12-22T04:41:26ZengThe Japanese Society for Spine Surgery and Related ResearchSpine Surgery and Related Research2432-261X2022-11-016671171610.22603/ssrr.2022-00052022-0005Temporary Monosegmental Fixation Using Multiaxial Percutaneous Pedicle Screws for Surgical Management of Bony Flexion-Distraction Injuries of the Thoracolumbar Spine: A Technical NoteKazuya Kitamura0Kentaro Fukuda1Yuichiro Takahashi2Takeshi Fujii3Masahiro Ozaki4Department of Orthopaedic Surgery, National Defense Medical CollegeDepartment of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu HospitalDepartment of Orthopaedic Surgery, Tokyo Dental College Ichikawa General HospitalDepartment of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu HospitalDepartment of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu HospitalIntroduction: The efficacy of minimally invasive surgeries for thoracolumbar flexion-distraction injuries (FDIs) has been reported, but those surgeries were monosegmental fusion surgeries of two adjacent vertebrae with bone grafts or temporary fixations using percutaneous pedicle screws (PPSs) that were at least bisegmental. Our idea was to fuse the fracture itself, not to fuse the fractured vertebra with an adjacent vertebra or to stabilize the fractured vertebra by bridging rostrally/caudally adjacent intact vertebrae, specifically when the displacement is minimal. This study aimed to present the surgical techniques of reduction and temporary monosegmental fixation of neurologically intact thoracolumbar bony FDIs using multiaxial PPSs, which can minimize the surgical invasiveness and preserve all motion segments, as well as report three cases treated with this procedure. Technical Note: When the fracture extended from the vertebral body to the spinous process at the same level, screws were placed into the fractured vertebra rostrally to the fracture along the rostral endplate, and the caudally adjacent vertebra was instrumented beyond the fracture line. When the fracture extended from the vertebral body to the spinous process of the rostrally adjacent vertebra, screws were placed into the fractured vertebra caudally to the fracture line, and the rostrally adjacent vertebra was instrumented. The kyphotic deformity was reduced through ligamentotaxis by using MPPSs in the rostral vertebra as rigid joysticks to apply direct buttress leverage to the rostral endplate. Intraoperative blood loss was minimal. The correction of kyphotic deformity and its durability were acceptable, and the segmental range of motion of the two affected vertebrae from flexion to extension was maintained after implant removal. Conclusions: This surgery can act as the least-invasive option for the management of thoracolumbar bony FDIs to allow early ambulation without external bracing and to preserve all the motion segments.https://www.jstage.jst.go.jp/article/ssrr/6/6/6_2022-0005/_pdf/-char/enflexion-distraction injurychance fracturemonosegmental fixationpercutaneous pedicle screwminimally invasive surgery |
| spellingShingle | Kazuya Kitamura Kentaro Fukuda Yuichiro Takahashi Takeshi Fujii Masahiro Ozaki Temporary Monosegmental Fixation Using Multiaxial Percutaneous Pedicle Screws for Surgical Management of Bony Flexion-Distraction Injuries of the Thoracolumbar Spine: A Technical Note Spine Surgery and Related Research flexion-distraction injury chance fracture monosegmental fixation percutaneous pedicle screw minimally invasive surgery |
| title | Temporary Monosegmental Fixation Using Multiaxial Percutaneous Pedicle Screws for Surgical Management of Bony Flexion-Distraction Injuries of the Thoracolumbar Spine: A Technical Note |
| title_full | Temporary Monosegmental Fixation Using Multiaxial Percutaneous Pedicle Screws for Surgical Management of Bony Flexion-Distraction Injuries of the Thoracolumbar Spine: A Technical Note |
| title_fullStr | Temporary Monosegmental Fixation Using Multiaxial Percutaneous Pedicle Screws for Surgical Management of Bony Flexion-Distraction Injuries of the Thoracolumbar Spine: A Technical Note |
| title_full_unstemmed | Temporary Monosegmental Fixation Using Multiaxial Percutaneous Pedicle Screws for Surgical Management of Bony Flexion-Distraction Injuries of the Thoracolumbar Spine: A Technical Note |
| title_short | Temporary Monosegmental Fixation Using Multiaxial Percutaneous Pedicle Screws for Surgical Management of Bony Flexion-Distraction Injuries of the Thoracolumbar Spine: A Technical Note |
| title_sort | temporary monosegmental fixation using multiaxial percutaneous pedicle screws for surgical management of bony flexion distraction injuries of the thoracolumbar spine a technical note |
| topic | flexion-distraction injury chance fracture monosegmental fixation percutaneous pedicle screw minimally invasive surgery |
| url | https://www.jstage.jst.go.jp/article/ssrr/6/6/6_2022-0005/_pdf/-char/en |
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