title: Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures.
abstract: Minimally invasive stabilization of thoracic and lumbar fractures without neurologic involvement is becoming a more frequent alternative to open fusion and conservative treatment. The authors analyzed the complication rate and limits of this technique in a consecutive series of 99 patients (127 thoracolumbar vertebral fractures) who underwent this technique between May 2005 and November 2009. Eighty-three patients had only spine injuries, whereas 16 had polytrauma injuries (mean Injury Severity Score, 25.2). In these 16 patients, percutaneous fixation was performed as a damage control procedure. The most frequent construct was monosegmental: 1 level above and 1 level below the fractured vertebra. In the remaining 21 patients, multilevel construction was performed for multiple injuries. Complications were analyzed according to the period of onset (intra- and postoperative) and the severity (major and minor). Twelve (12%) complications were recorded: 4 (4%) were intraoperative, 6 (6%) were early postoperative, and 2 (2%) were late postoperative; 4 (4%) were minor and 8 (8%) were major. Mean follow-up was 52 months (range; 36-90 months). All patients except 1 were considered healed after 6-month follow-up. The failed patient had an initial kyphosis greater than 20°, and a posterior open reduction and fusion would have been more appropriate. Minimally invasive stabilization of selected spine injuries is a safe technique with a low complication rate. The main goal of this approach is a fast recovery time, so any complication leading to an extended length of stay should be considered severe. An adequate learning curve is important to minimize complications.
authors.affiliation: Department of Orthopedics and Traumatology-Spine Surgery, Ospedale Maggiore C.A. Pizzardi, Largo Nigrisoli 2, 40100 Bologna, Italy. m.cappuccio73@gmail.com
authors.forename: Michele
authors.initials: M
authors.lastname: Cappuccio
authors.forename: Luca
authors.initials: L
authors.lastname: Amendola
authors.forename: Stefania
authors.initials: S
authors.lastname: Paderni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bosco
authors.forename: Giovanbattista
authors.initials: G
authors.lastname: Scimeca
authors.forename: Loris
authors.initials: L
authors.lastname: Mirabile
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Federico
authors.initials: F
authors.lastname: De Iure
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries*; D055815:Young Adult