The use of minimally invasive surgery in spine trauma: a review of concepts

Abstract

Traumatic injuries to the spine can be common in the setting of blunt trauma and delayed diagnosis can have a deleterious effect on patients' health. The goals of treatment in managing spine trauma are prevention of neurological injury, providing stability to the spine, and correcting post-traumatic deformity. Minimally invasive spine surgery (MISS) techniques are an alternative to open spine surgery for treatment of spine fractures. MISS is also a viable treatment in the setting of damage control orthopedics, when patients with multiple traumatic injuries may be unable to tolerate a traditional open approach. MISS techniques have been used in the treatment of unstable fractures with or without spinal cord injury, flexion and extension-distraction injuries, and unstable sacral fractures. Traditional open surgeries have been associated with increased blood loss, longer operative times, and a higher risk for surgical site infection (SSI). MISS techniques have the potential to reduce open approach-associated morbidity, and improve postoperative care and rehabilitation. MISS techniques for spine trauma are an indispensable option in the treatment armamentarium of spine surgeons.

Keywords: Spine trauma; damage control orthopedics; minimally invasive spine surgery (MISS); spine fractures; thoracolumbar (TL) spine.

Figure 1

L1 burst fracture treated with short-segment fixation. (A) Coronal CT; (B) intra-operative fluoroscopy; (C) sagittal CT; (D) post-operative lateral X-ray.

Figure 2

True AP fluoroscopic image being used to cannulate the pedicles of a lumbar vertebra. Left pedicle has been cannulated with a Jamshidi needle, and a flexible wire is being passed through the needle. Ultimately this wire will guide placement of a cannulated pedicle screw. AP, antero-posterior.

Figure 3

Case of 22-year-old that presented with a flexion distraction injury and T12 burst fracture with canal retropulsion. (A) Mid-sagittal showing flexion-distraction injury of T11 posterior elements and a T12 burst fracture; (B) axial CT of T12 showing retropulsion into spinal canal; (C) intra-operative anterior-posterior fluoroscopy; (D) post-operative lateral X-ray of thoracolumbar spine.