Analysis of complications and perioperative data after open or percutaneous dorsal instrumentation following traumatic spinal fracture of the thoracic and lumbar spine: a retrospective cohort study including 491 patients.

PURPOSE: The aim of the current study is to analyze perioperative data and complications of open vs. percutaneous dorsal instrumentation after dorsal stabilization in patients suffering from fractures of the thoracic or lumbar spine. METHODS: In the time period from 01/2007 to 06/2009, open surgical approach was used for dorsal stabilization. The percutaneous surgical approach was used from 05/2009 to 03/2014. In every time period, all types of fractures were treated only by open or by percutaneous approach, respectively, to avoid any selection bias. Retrospectively, epidemiological data, complications and perioperative data were documented and statistically analyzed. RESULTS: A total of 491 patients met the inclusion criteria. Open surgery procedure was carried out on 169 patients, and percutaneous surgery procedure was carried out on 322 patients. Fracture level ranged from T1 to L5, and fractures were classified types A, B, and C. In 91.4% of all patients, no complication occured following dorsal stabilization after traumatic spine fracture during their hospital stay. However, 42 complications related to dorsal stabilization have been documented during the hospital stay. The complication rate was 14.8% if open surgical approach has been used and was significantly reduced to 5.3% using percutaneous surgical approach. Post-operative hospital stay was also reduced significantly using the percutaneous surgical approach. CONCLUSIONS: According to the current study, percutaneous dorsal stabilization of the spine could also be safely used in trauma cases and is not restricted to degenerative spinal surgery.

Comparison of pedicle screw misplacement following open vs. percutaneous dorsal instrumentation after traumatic spinal fracture.

OBJECTIVE: Dorsal stabilization is a frequently used procedure in the treatment of acute traumatic vertebral body fractures. Besides the traditional open surgical procedure, the percutaneous positioning of pedicle screws is now widely used. The aim of the current study is to compare pedicle screw misplacement following open vs. percutaneous dorsal instrumentation after traumatic spinal fracture of the thoracic and lumbar spine and to assess possible risk factors associated with pedicle screw misplacement. METHODS: All patients who suffered a traumatic spinal fracture that were treated with dorsal stabilization in our level I trauma center in the period from 01/2007 to 03/2014 were included in this retrospective therapeutic cohort study. From 01/2007 to 06/2009, an open surgical procedure was used, and from 06/2009 to 03/2014, the percutaneous procedure was used for all types of fractures. Retrospectively, the positioning of every single pedicle screw was evaluated in the post-operative computed tomography scan and classified. Epidemiological data were also documented to compare the two treatment groups. RESULTS: A total of 491 patients with 681 vertebral body fractures were included. Of 733 pedicle screws placed during the open surgery procedure, 96.0% were within the safe zone. There was no significant difference compared with pedicle screws placed percutaneously (95.3% of 1884 screws). In all other categories, the number of misplaced pedicle screws also showed no differences between the two treatment groups. There is a positive correlation between pedicle screw misplacement and duration of the operation. Most pedicle screws are misplaced at the levels T12, L1 and T7, T8. CONCLUSION: The current study shows that percutaneous surgery using dorsal stabilization allows the positioning of pedicle screws in an equivalently safe manner compared with an open surgical procedure in the acute care of spinal trauma.

Reduction in Traumatic Spine Injuries in the Thoracic and Lumbar Spine With Percutaneous Versus Open Dorsal Stabilization.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Doubts still remain whether a sufficient reduction of vertebral body fractures can be achieved if a percutaneous surgical approach is adopted. The aim of this retrospective cohort study was to analyze the reduction and perioperative complications using a percutaneous versus open surgical approach for dorsal stabilization. METHODS: Patients suffering from a traumatic injury of the thoracic or lumbar spine who were treated with dorsal stabilization at our level 1 trauma center were included. From January 2007 through June 2009, only the open approach was used; from June 2009 through March 2014, only the percutaneous approach with a special reduction technique was used. Retrospectively, total reduction, perioperative and intraoperative data, and postoperative complications were analyzed. RESULTS: Using the percutaneous (n=185) versus open surgical approach (n=91), the mean reduction over all spinal injuries was 7.7±6.6 versus 8.3±5.5 degrees, respectively. The mean operation time was 75.5±50.2 versus 71.5±41.9 minutes, respectively. There was no significant difference between the 2 treatment groups in terms of the total reduction (P=0.753) or operation time (P=0.814).After the percutaneous and open surgical approach, 7 (3.8%) and 22 (24.2%) complications were documented. Complications requiring interventions were more frequent in the open treatment group. CONCLUSIONS: Percutaneous dorsal stabilization seems to be a good alternative to the traditional open surgical approach. The fracture's reduction is similar, whereas severe complications are reduced and the operation time is not prolonged. LEVEL OF EVIDENCE: Level III-retrospective cohort study.