Minimally Invasive Spine Osteosynthesis (MISO) Technique for Fractures Spine: A Case Series 14 Cases

Background: The choice of treatment of dorso-lumbar spinal fractures in the absence of neurological deficit depends on the classification and severity of injury. In the conventional open approach with posterior pedicle screw fixation, detachment of the Para spinal muscles may be required. In addition, this open approach may be disadvantaged by prolonged operative time, increased intraoperative bleeding and delayed functional rehabilitation. All these problems appear to encourage orthopedic surgeons to limit secondary iatrogenic insult in these patients by mini open surgery. The goal of this study is to evaluate the effectiveness of minimally invasive treatment of dorsolumbar fractures by mini open surgical pedicle screw fixation and to discuss the potential benefits and drawbacks of this procedure. Patients and methods: This is a prospective study involves 14 Patients (10 males) treated and followed between Feb. 2010 to Feb 2014. All had acute traumatic single level dorso-lumbar spine fractures, age range 17-47 years (mean 30.1 ± 7.9 yrs). Patients with pathological fractures, neurological injury, anatomical variations of the cord or vertebrae, mental illness, significant surgical contraindications, osteoporosis, refusing to sign informed consent and those with (TLICS) score ≤4 or load sharing score ≥7 were excluded from the study. All the cases had been treated by minimal invasive posterior approach. Total of 56 screws and 28 rods were applied utilizing the conventional posterior instrumentation. Results: Mean post-operative hospital stay 3.8 days. No major complications as spinal cord, nerve root or blood vessel injuries occurred. No screws were broken and just two screws were malpositioned. All patients improved clinically, and the outcome (according to modified MacNab criteria) was considered excellent in six patients, good in seven, and poor in one patient. Conclusion: Mini open surgery for posterior pedicle screws fixation has attracting increasing attention as it brings a multitude of advantages including: less bleeding, lower incidence of postoperative intractable low back pain and reduced hospitalization stay. However; some shortcomings as limited indications, unsuitability for long segment fusion and high load-sharing score patients restricts its worldwide prevalence.