Safety and Efficacy of Percutaneous Non-Canulated Transpedicular Screws Fixation (TPSF) in the Management of Thoracolumbar Fractures

Background Data: The use of pedicle screws for spinal stabilization has become increasingly popular worldwide. Standard open techniques for pedicle screw placement, however, require extensive tissue dissection to expose entry points and to provide lateral to medial orientation for optimal screw trajectory. Minimal invasive techniques (MIT) are widely accepted as being the less aggressive procedure in any kind of surgery. Purpose: The aim of this study was to describe and evaluate a new alternative percutaneous technique using the usual economic non-canulated screws in thoracolumbar fractures. Study Design: A prospective clinical case study. Patients and Methods: Between January 2007 and December 2012, 42 patients (31 males and 11 females) with thoracolumbar fractures were admitted to emergency department of Assiut University Hospital. The mean age of the patients was 37 years (range, 19 to 57). All fractures were classified according to Magerl’s classification. According to American Spinal injury Association (ASIA) Impairment Scale (AIS), all patients were neurologically free (ASIA grade E) preoperatively. Surgery was done within 72 hours after injury. All patients underwent ligamentotaxis through percutaneous posterior approach using non-canulated transpedicle screws. The kyphotic angle was measured according to Cobb method preoperatively, postoperatively, and at latest follow up. Postoperative CT was done for all patients to verify screw position and recording of pedicle violations. Results: The mean operative time was 65 minutes (range, 55 to 120). The mean operative blood loss was 54 ml (range, 35 to 90). The mean preoperative local kyphotic angle (LKA) improved from 12° to -2° postoperatively and 2° at latest follow up. Neurological deterioration occurred in one patient. The average hospital stay was 1.5 days (average, 1 to 3). Misplacement of the screws (3 screws violated the medial wall of the pedicle, 7 violated the lateral wall) was recorded in 10 of 186 screws (5.4%). Conclusion: The percutaneous pedicle screw insertion using non-canulated technique in thoracolumbar spine fracture is safe, economic, and reliable minimal invasive technique. (2013ESA047)