Authors: James Andrew Stadler III, MD; Kimberly Hamilton, MD; Stephanie Armstrong, MS (Madison, WI)
Unstable thoracolumbar fractures in younger patients are frequently treated utilizing extrapolated biomechanical principles from older adult populations. There is growing experience treating older adults with percutaneous pedicle instrumentation for temporary internal bracing; this has not been well-studied in children and young adults. This newer minimally invasive technique allows for preservation and healing of the injured osteoligamentous structures, while avoiding permanent fusion ultimately returns segmental range of motion when the instrumentation is later removed. This has particular benefit in the younger population with greater healing potential and longer remaining life expectancy.
Between 2017 and 2019, four patients were treated with minimally invasive percutaneous pedicle instrumentation for internal bracing of an unstable thoracolumbar fractures. Patient age ranged from 16 to 23, and spinal level ranged from T12 to L3. Two patients had burst-type fractures, and two had Chance-type fractures. Each patient either failed or had contraindications to external bracing.
Each patient demonstrated successful fracture healing and underwent subsequent instrumentation removal. Postoperative dynamic imaging demonstrated preserved segmental motion, with an average range of motion spanning fracture-adjacent levels of 17 degrees (range 7 – 33 degrees). There were no noted complications from any surgery in this early experience.
Similar to the reported experience in the older adult population, the early experience of percutaneous pedicle instrumentation for temporary stabilization of thoracolumbar fractures in children and young adults is encouraging. Segmental thoracolumbar range of motion can be preserved in young patients with select injury patterns, potentially avoiding the lifelong sequelae of thoracolumbar fusions.