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MIS options for

Spinal Trauma
• Assistant Professor, Department of
Orthopedics, Boston University
• Chief of Spine, Boston University
• Founding President, Society for
Progress & Innovations for the Near East
• Interest:
• MIS, Deformity, Tumors
• Designs: Viper, Lateral Cougar cage
• Medical education exchange: national and
international
Tony Tannoury, MD • Enjoys Tennis, Ski, Travel, Social
Networking
• Contact: www.neareastspine.org
MIS options for Spinal Trauma

TONY Y. TANNOURY, MD
Assistant Professor,
Department of orthopedic
Boston University

 Disclosure:
– Consultant to Depuy,
Johnson & Johnson Co
– Receive Royalty on some
products that are shown in
this talk
– This study was not funded
nor supported by Depuy
Burst fractures
Operative Indications
Technique
 Patient: prone position:
– hyper-extension
 Radiolucent table
 Include the fracture level
 All percutaneous fixations
 All short segment
– One level above
– One level below
 for NON Fusion group:Planned
ROH:4-8 ms po
ENTRY POINT
MID-PEDICLE
NC
JUNCTION
Treatment options
considerations
 Can you patient go
through a long fusion
procedure
 Can you patient
tolerate a brace
Surgical options:
 Posterior fusion
 Anterior fusion
 Anterior/posterior
fusion
 other
Fractures’ evaluation

A C
 ThoracoLumbar Injury Classification System: TLICS:
– TL point system that assists in clinical decision making
 Morphology of injury (1-4 points)
 Integrity of the PLC (0-3 points)
 Neurological status (0-3 points)
– Operative (>5pts) versus Nonoperative approach(<3pts)
– Surgical Approach
 STSG Spine 2005
Treatment recommendations

BRACING SURGERY
Treatment recommendations
complexities

80
70
60
Open
50
fusion
40 BRACING SURGERY
BRACING 30 FUSION

20
10
bracing
0
Rx Morbidity
42 YO fell off three story building
Plateau Fracture

 Rx options:
– Bracing or Cast?
– Knee fusion?
– Other: ORIF!!!!
Rx options
 Casting/bracing?
 External fixation
 Knee fusion?
 Other???
Pilon Fracture
Treatment options

ORIF
EXTERNAL
FIXATION
Study design:
 Retrospective review
 Consecutive 53 cases
 Unstable spinal column
fractures
 Neurology:
– intact or complete: non
fusion
– Incomplete:
decompression and fusion
 Outcome measures:
– Pain Score
– Complications
– Fracture reduction
 Initial
 final
GOAL: traumatic conditions
 To look at our experience
in trauma patient
population
– Less than optimal condition
– Anatomy is often distorted
– Need for some
manipulation/reduction
– Fragile patients: may or may
not tolerate our spinal
procedure
45 yo s/p fall
severe right LE weakness

L2

L1

L1
Final X-rays
42 yo S/P MCA
Severe lung contusion
left femur and pelvis fx
6 mos PO
After removal of hardware.
NO FUSION
3 mos post op
67 yo. Fall of a height. NV Intact
Post op.
Time will judge
22 yo teacher/model
Post op
4 months post op
Post removal of hardware
18 YO lady. s/p 20 ft height fall
Neurology: intact
3 COLUMN INJURY

L4 L4
INTRA-OP Myelogram
Post op
Post reduction
2 mos post op
2 weeks post op
POST ROH
48 yo male, s/p fall
severe right leg weakness
options
 Bracing
 Anterior
 Posterior
 Anterior and posterior
Post op: percutaneous reduction
NO FUSION
6 months post op
4 mos post ROH
Pelvic vertical shear instability
Iliac Lumbar stabilization
Temporary
3 moths post op.
Study design:
 Retrospective review
 Consecutive 38 cases
 Unstable spinal
column fractures
 Neurology: intact or
complete
 Outcome measures:
– Pain Score
– Complications
– Fracture reduction
 Initial
 final
CRPF OF THORACOLUMBAR FRACTURES WITH
AND WITHOUT FUSION: SAFETY AND OUTCOME
CPRF BURST Fractures with Fusion
FRACTURES Internal stabilzation
# PATIENTS/#Screws 38/201 15/96
# CT SCANS/#screws 26/131 11/50
# BREACHES 10 (5C, 5NC) 0
AVG BLOOD LOSS 66 ml 355ml
Average F/U 21 Months 21 months
AVG TANSFUSION 170 ml 450 cc
COMPLICATIONS one None
INFECTION - o
PLANNED ROH 31 0

KYPHOSIS 14.4° to 1.8° 17 to 5


CORRECTION: pre-tx
and post-tx avg
Unplanned Reopreation one 0
VAS 1.8 3.2
Discussion
 Complications: comparable to open
– Reduction: reliable
– Infection: much lower
conclusion
 Percutaneous screw
fixation is an effective
method in treatment of
Unstable spinal fractures
 Safe
 Able to reproduce desired
stability and sagittal
balance
Conclusion
Open Surgery

 Criminal
Conclusion:
Advantages of MIS Rx

 No fusion is a
great option
FUSION?