Use of a Skin-Fixed Dynamic Reference Frame in Spinal Trauma Surgery: A Case Report

Intraoperative CT navigation has revolutionized spinal surgery by enhancing precision, particularly in pedicle screw placement. However, the traditional use of bone-fixed dynamic reference frames (DRFs) often necessitates placement on spinous processes, complicating percutaneous pedicle screw (PPS) insertion and requiring additional incisions. This case report presents a novel approach utilizing a skin-fixed DRF in spinal trauma surgery. A 26-year-old female sustained lower limb paralysis, sensory impairment, and bladder-rectal dysfunction after a 15 m fall, resulting in an L1 fracture-dislocation (American Spinal Injury Association score C, Thoracolumbar AOSpine Injury Score score 13). The radiological assessment confirmed dural sac compression. An emergency damage control surgery was conducted using a skin-fixed DRF, secured with sutures and tape near the PPS insertion site. Intraoperative CT navigation guided the insertion of PPS from T11 to L3. The procedure lasted 141 minutes with an estimated blood loss of 256 mL. Postoperative CT verified accurate screw placement. At six months postoperatively, the patient exhibited significant motor recovery and regained independent ambulation. The skin-fixed DRF technique minimizes surgical complexity, obviates the need for additional incisions, and mitigates the challenges associated with bone-fixed DRFs during PPS procedures. This method demonstrates potential as a minimally invasive and effective surgical technique in spinal trauma cases.