Minimally invasive treatment of thoracolumbar flexion-distraction fracture

Flexion-distraction fractures represent around 15% of all thoracolumbar fractures, with neurological deficit in 25% of cases. Optimal surgical strategy remains controversial. In neurologically intact patients, percutaneous fixation can offer quick stabilization with good deformity correction. If necessary, an additional minimally invasive anterior approach can complete the surgical strategy. We report results in a series of 28 thoracolumbar flexion-distraction fractures without neurologic deficit, treated using a minimally invasive approach.

A single-center retrospective study was conducted for the period 2008-2015. Patients over 16 years of age with a flexion-distraction fracture without neurologic deficit were included. Analysis was based on preoperative CT-scan and measurement of post-traumatic kyphotic deformity. Surgery comprised posterior percutaneous fixation, alone or associated to an anterior step in case of discal lesion on preoperative MRI or of severe vertebral comminution. Operative time, blood loss and postoperative complications were recorded. Residual segmental kyphosis and bone healing were evaluated on CT at 1 year.

Seventeen males and 11 females were included (mean age, 29.2 years). An anterior approach was performed in 11 cases (39%): 5 for B1 fractures due to severe comminution (corpectomy and expandable vertebral cage with bone and BMP-2) and 6 for B2 fractures due to discal involvement on MRI (discectomy and iliac graft fusion). Regional kyphosis was significantly reduced (17.3° vs. 5.7°; p<0.05) and bone healing was obtained in all cases. There were no cases of postoperative infection.

Patients with flexion-distraction fractures without neurologic deficit can be eligible for minimally invasive percutaneous posterior fixation, associated if necessary to a minimally invasive anterior approach. This technique provides excellent bone healing with low surgical trauma and bleeding.

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