Role of Minimal Invasive Spine Surgery Techniques in Thoracolumbar Burst Fractures

Thoracolumbar burst fractures are one of the most common traumatic fractures seen. Management options vary from nonoperative to operative. Among the operative approaches, minimal invasive approaches are gaining popularity. However, all the cases are not suitable for minimal invasive approaches. We discuss the various minimal invasive approaches and their role in the management of thoracolumbar burst fractures.

Smart Device Based Application for Rod Determination in Minimal Invasive Spine Surgery

In orthopaedic spine surgery pedicle screw systems are used for stabilisation of the spine after injuries or disorders. With an percutaneous operation method surgeons are faced with huge challenges compared to an open surgery, but it`s less traumatic and the patient benefits with a faster rehabilitation and less traumatic injuries. The screw positions and the required rod dimensions for the stabilizing connection between the screws are hard to define without an open view on the operating field. Because of these facts a new smart device based system for rod shape determination was invented. Therefore, an application was developed, which integrates a localizer module to get the position data of the pedicle screws, with help of rigid bodies placed on top of the pedicle screws down-tubes. An algorithm was developed to choose the best fitting rod to connect the pedicle screws with help of calculating the rod length and the rod radius. The system was tested in a test scenario where four pedicle screws were drilled into a wooden plate. The positions of the screws were adjusted to fit a curved and a straight rod. In the test scenario the application chose always the rod correctly.

Minimal-invasive lumbale Wirbelsäulenchirurgie: historischer Rückblick, aktueller Stand und Ausblick

Die lumbale Wirbelsäulenchirurgie ist seit Jahrzehnten von sogenannten «offenen dorsalen Zugängen» geprägt, die – obwohl etabliert – mit z.T. erheblichen Kollateralschäden im Bereich des operativen Zugangsweges assoziiert sind. Seit über zehn Jahren gibt es zunehmend minimal-invasive spinale Operationsmethoden (minimal invasive spine surgery, MISS), die deutlich weniger destruktiv und weniger traumatisch sind. Zu den Vorteilen zählen unteren anderem kleinere Hautinzisionen, geringeres Weichteil- und Muskeltrauma, geringerer perioperativer Blutverlust, erniedrigte Infektionsrate, raschere Mobilisierung, kürzerer Spitalaufenthalt und raschere postoperative Arbeitsfähigkeit. Diese Vorteile müssen jedoch gegenüber potenziellen Nachteilen abgewogen werden, zu welchen unter anderem eine erschwerte Orientierung für den Chirurgen, steilere Lernkurve sowie eine vermehrte Strahlenbelastung gehören. Dieser Artikel gibt einen Überblick über die Evolution und die aktuellen Möglichkeiten der MISS.

Minimal Invasive Anterior Decompression in Tuberculosis of Thoracolumbar Junction of the Spine – Experience With SynFrame

Introduction: This study assesses the role of new retractor system SynFrame for anteriordecompression of tuberculosis of thoracolumbar junction of the spine.Methods: This study includes fi ve consecutive patients with tuberculosis of thoracolumbar junctiontreated with minimal invasive anterior decompression using a new table mounted retractor systemSynFrame (Stratec Medical, Switzerland). The thoracolumbar junction was approached by a left sidedthoracotomy. Short construct pedicle screw stabilization was done in all cases before decompression.The anterior column was reconstructed using expandable cage (n=3) and autologous tricortical graft(n=2).Results: The mean operating time was 100 minutes (range 90-120). Mean overall blood loss was 400ml. No operation had to change into an open procedure. There were neither intra nor postoperativecomplications related to minimal access in particular, nor visceral/vascular complications.Conclusions: The ring retractor system allows minimal open surgery to the spine by carryingdifferent devices as well as endoscope, providing an excellent visualization of the operating fi eld,and is safe and easy to use. The only disadvantage is its high cost.Key Words: anterior decompression, minimal invasive spine surgery, SynFrame