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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
Criminal
Conclusion:
Advantages of MIS Rx
No fusion is a
great option
FUSION?