Minimally Invasive Spine Osteosynthesis (MISO) Technique Versus Traditional and Paraspinal Posterior Open Approaches for Treatment of Thoracolumbar Spine Fractures

The treatment of fractures of the thoracic lumbar spine remains controversial. Single-segment fractures without neurologic injury treated by pedicle screw fixation posterior short-segment (PS), surgical technique can be either through posterior midline incision or paraspinal posterior open approaches or Percutaneous.

The goal of this study is to evaluate the effectiveness of minimally invasive treatment of dorso-lumbar fractures by mini open surgical pedicle screw fixation.

This study involves Patients of acute traumatic single level dorsolumbar spine fractures requiring surgical intervention were included in this study. Twenty eight patients (20 male, 8 female), age range 17-47 years (mean 30.1 ± 7.9 yrs) with dorso-lumbar fractures (D12:8, L1:13, L2:4, L3:3) with TLICS score>4 were studied (Feb 2009-Feb 17). Total of 112 screws were put of which 3 screws were mal positioned (2.6%). Open conversion was done in two cases (7.1%) due to difficulty in screw positioning. In one case, screw pull out was noted intra operatively during ligamentotaxis and rod manipulation.

Results: No patient had post-operative neurological deterioration. Mean post-operative hospital stay was 3.1 days. The average blood loss is 94 ml. Follow-up scans showed satisfactory correction of deformity. Good to excellent outcome was present in 92, 8%.

Conclusion: We conclude that mini open surgery for pedicle screws fixation is a safe, reliable, cost effective technique with favorable results in acute polytrauma cases requiring standalone ligamentotaxis. Complex biomechanics/physics of instrumentation, lack of adequate fusion and steep learning curve during initial cases with increased radiation exposure limits its application in all cases.

Keywords: spine fixation, minimal spine fixation, pedicular screw fixation, Fr. Spine.