Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

Summary

The sagittal adjusting screw (SAS) system has been widely used for thoracolumbar (TL) spinal trauma. Percutaneous options and specialized trauma reduction devices are also available for the SAS system. We describe a technique for reducing TL burst fractures using an SAS system and a newly introduced trauma reduction device.

Abstract

Thoracolumbar (TL) burst fracture is one of the most common indications for minimally invasive percutaneous pedicle screw fixation. Although the indication for surgical treatment of neurologically intact TL fractures remains under debate, studies have demonstrated that posttraumatic malalignment may lead to a deterioration in the patient's quality of life. For burst fractures with malalignment or fragments in the spinal canal, a reduction technique using ligamentotaxis is commonly used to improve long-term outcomes.

The sagittal adjusting screw (SAS) system is a monoaxial screw system with a fixed head and concave sliding saddle that allows lordotic sliding of the rod in the sagittal plane after screw insertion. SAS also has a percutaneous option and has been used for TL spine fractures. Notably, the SAS only allows motion on the sagittal plane, allowing both secure fixation and angular reduction. The SAS has certain advantages over the conventional Schanz screw system or normal mono-/multiaxial pedicle screws for TL spine fracture treatment. In addition, specialized trauma reduction devices are available for the SAS system. In this video protocol, we discuss the indication for the SAS system in TL burst fracture and describe a technique of TL burst fracture reduction and fixation using the SAS system. Additionally, we describe our recent case series with radiological evaluation, including regional kyphotic angle and percent loss of anterior vertebral body height, to evaluate the newly introduced trauma reduction device.

Introduction

Thoracolumbar (TL) burst fractures are relatively common, occurring in approximately 20% of all vertebral fractures¹, and are characterized by retropulsion of the fractured middle column fragments into the spinal canal. Although the management of TL burst fractures has been extensively studied, the indication for surgical treatment remains under debate. Previous studies have reported that long-term functional outcomes may not differ substantially between operative and nonoperative treatment for neurologically intact TL burst fractures¹. Nevertheless, these comparative studies were launched decades ago, making their resul....

Protocol

This protocol was approved by the Institutional Review Board of Showa University Hospital (No.2023-017-A) and conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The protocol follows the guidelines of our institution's human research ethics committee. As this representative case series is retrospective in nature, informed consent from each patient was waived in accordance with the institutional review board policy. Informed consent was obtained from patients presented in the f.......

Discussion

In this video manuscript, we describe our posterior minimally invasive fixation procedure for TL burst fractures using the SAS system and a trauma reduction device. Our representative case series showed good correction of the local kyphotic deformity and vertebral morphology. In previous studies, the potential reduction of kyphosis is 5-9% using an open approach³⁰. Our data demonstrated results comparable to those of the open approach, even with a percutaneous approach. This is consistent with one.......

Materials

Name	Company	Catalog Number	Comments
3M Ioban 2 antimicrobial incise drape	3M	MSDS_0832279_US_EN_RDS	Iodophor-impregnated adhesive incision drape
CDH Solera Longitude II  SAS	Medtronic		SAS system
CDH Solera Voyager FNS SAS	Medtronic		SAS system
DERMABOND ADVANCED Topical Skin Adhesive	Ethicon Inc.		Topical skin adhesive glue or thin adhesive bandage
INFINITT PACS	INFINITT Healthcare Co., Ltd.		Picture archiving and communication system
Jewett brace	(Various manufacturers)		Jewett type brace
Nforce Trauma	Medtronic		Trauma reduction device
OEC Elite	GE healthcare		Fluoroscopy/image intensifier/c-arm
Sacro-wide Dx	Alcare	368-0208-0223/5	Soft brace
Steri Strips Standard Skin Closure	3M	MSDS_1084623_US_EN_AIS	Thin adhesive bandage.
Trauma Instrument Set	Medtronic		Trauma reduction device
Vicryl Plus Antibacterial 0	Ethicon Inc.	VCP587H	Antibacterial absorbable poly-filament suture
Vicryl Plus Antibacterial 2-0	Ethicon Inc.	VCP453H	Antibacterial absorbable poly-filament suture
Vicryl Plus Antibacterial 3-0	Ethicon Inc.	VCP398H	Antibacterial absorbable poly-filament suture