Minimally Invasive Pedicle Screw Fixation With Indirect Decompression by Ligamentotaxis in Pathological Fractures

Effect of posterior decompression and bone grafting combined with minimally invasive percutaneous pedicle screw fixation on pain and functional recovery in patients with thoracolumbar spinal fractures

OBJECTIVE

This study aimed to investigate the effects of posterior decompression and bone grafting combined with minimally invasive percutaneous pedicle screw fixation (MIPSF) on pain relief and functional recovery in patients with thoracolumbar spinal fractures.

METHODS

This prospective, randomized controlled trial included 68 patients with thoracolumbar spinal fractures, who were divided into control and observation groups. Perioperative outcomes, visual analogue scale (VAS), Oswestry Disability Index (ODI), American Spinal Injury Association Impairment Scale, vertebral anterior height, vertebral sagittal index, Cobb's Angle, serum substance P (SP), serum cortisol (Cor), and C-reactive protein (CRP) levels, were evaluated. Postoperative complications were also recorded.

RESULTS

The observation group exhibited reduced operation time, intraoperative blood loss, drainage volume, and hospital stay, lower VAS and ODI scores, higher sensory and motor scores, improved injured vertebral anterior height and sagittal index, decreased kyphotic Cobb's angle, and lower serum SP, Cor, and CRP levels versus the control group (p < 0.05). The postoperative complication rate was 5.88% in the control group and 2.94% in the observation group (p > 0.05).

CONCLUSION

The combination of posterior decompression, bone grafting, and MIPSF for thoracolumbar spine fractures results in less traumatic stress, improved postoperative pain management, and better recovery of spinal function.

Oblique Lateral Endoscopic Decompression and Interbody Fusion for Severe Lumbar Spinal Stenosis: Technical Note and Preliminary Results

OBJECTIVE

Adequacy of decompression for oblique lateral interbody fusion (OLIF) is a real concern in patients with severe lumbar spinal stenosis (LSS). With this in mind, we combined OLIF with spinal endoscopic technique to achieve a solid fusion and an adequate decompression after one operation.

METHODS

This is a technical note. The theoretical basis and operation process of this technique were introduced, and consecutive cases were retrospectively collected. Consecutive patients diagnosed with monosegmental severe LSS (L4/5) and underwent oblique lateral endoscopic decompression and interbody fusion (OLEDIF) from January 2018 to February 2020 were retrospectively collected. Clinical outcomes were assessed by claudication distance, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores. Secondary indicators included operation time, operative blood loss, and postoperative complications.

RESULTS

Ten patients were selected for the OLEDIF procedure. They were five women and five men ranging in age from 49 to 75 years (mean age of 63.9 years) and in BMI from 25.4 to 30.2 kg/m² (mean BMI of 27.5 kg/m² ). The preoperative claudication distance was 160.00 ± 68.96 m (range 70-250 m), which was significantly extended on the 3-month and 1-year follow-up (1020.00 ± 407.70 m and 1040.00 ± 416.87 m, respectively). The preoperative VAS score of back pain and radiating leg pain was 5.50 ± 0.97 (range 4-7) and 6.40 ± 0.97 (range 5-8). The score on postoperative month 3 was 1.60 ± 0.52 (range 1-2) and 1.20 ± 0.79 (range 0-2), and the 1-year follow-up score was 1.90 ± 0.74 (range 1-3) and 1.60 ± 0.70 (range 1-3), respectively. The preoperative ODI was 72.23 ± 6.30 (range 64.4-82.2), the 3-month follow-up ODI was 31.12 ± 4.20 (range 24.4-35.6), and the 1-year follow-up ODI was 29.33 ± 5.92 (range 20.0-37.8). Compared with the transforaminal lumbar interbody fusion (TLIF) in the literature, the operation time was not prolonged (189.3 ± 32.5 min vs. 214.9 ± 60.0 min) but the amount of blood loss decreased significantly (113.3 ± 26.7 ml vs. 366.8 ± 298.2 ml). No complications were found except one case presented with dysesthesia of the left leg. Imaging results showed good fusion without cage subsidence during 1-year follow-up.

CONCLUSION

OLEDIF can achieve complete ventral decompression of the spinal canal and solid fusion of the lumbar spine at one time. It is an effective minimally invasive technique for the treatment of monosegmental severe LSS, which is promising and worthy of further clinical practice.

Unilateral Biportal Endoscopic-Guided Transcorporeal Vertebroplasty with Neural Decompression for Treating a Traumatic Lumbar Fracture of L5

BACKGROUND

Lumbar burst fractures (complete or incomplete) of L5 have a low incidence, accounting for 1.2% of all spinal burst fractures. Treatment for these fractures remains controversial. Decompression of neural elements and stabilization of the spine to preserve lordosis and avoid kyphotic deformity are recommended when a patient has a neurological deficit and an unstable fracture. Otherwise, the fracture could be managed conservatively.

METHODS

We report a detailed step-by-step unilateral biportal endoscopy technique used in a patient with an L5 incomplete burst fracture and neurological deficit.

RESULTS

The patient had an acceptable immediate postoperative course; lower back pain and radicular symptoms improved significantly after surgery.

CONCLUSIONS

Our unilateral biportal endoscopy technique for L5 incomplete burst fractures offers the capability to perform enough decompression of neural elements and assist other procedure-related maneuvers under direct endoscopic visualization. This technique could be considered another minimally invasive spine surgery option for treating selected patients with L5 incomplete burst fractures.