Traumatic thoracolumbar spinal injury: an algorithm for minimally invasive surgical management

Sanjay S Dhall, Rishi Wadhwa, Michael Y Wang, Alexandra Tien-Smith, Praveen V Mummaneni
Neurosurgical Focus 2014, 37 (1): E9

OBJECT: Minimally invasive spinal (MIS) surgery techniques have been used sporadically in thoracolumbar junction trauma cases in the past 5 years. A review of the literature on the treatment of thoracolumbar trauma treated with MIS surgery revealed no unifying algorithm to assist with treatment planning. Therefore, the authors formulated a treatment algorithm.

METHODS: The authors reviewed the current literature on MIS treatment of thoracolumbar trauma. Based on the literature review, they then created an algorithm for the treatment of thoracolumbar trauma utilizing MIS techniques. This MIS trauma treatment algorithm incorporates concepts form the Thoracolumbar Injury Classification System (TLICS).

RESULTS: The authors provide representative cases of patients with thoracolumbar trauma who underwent MIS surgery utilizing the MIS trauma treatment algorithm. The cases involve the use of mini-open lateral approaches and/or minimally invasive posterior decompression with or without fusion.

CONCLUSIONS: Cases involving thoracolumbar trauma can safely be treated with MIS surgery in select cases of burst fractures. The role of percutaneous nonfusion techniques remains very limited (primarily to treat thoracolumbar trauma in patients with a propensity for autofusion [for example, those with ankylosing spondylitis]).

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