Minimally invasive surgery for thoracolumbar spinal trauma
The indications for operative intervention after thoracolumbar spine trauma have been well described. Advances in minimally invasive techniques, including percutaneous pedicle screw fixation and mini-open anterolateral retractor-based approaches can improve surgical outcomes when appropriately applied by reducing blood loss, operative duration and post-operative pain. Moreover, they allow for theoretical advantages by preservation of muscular and skeletal blood supply and innervation that is typically lost during the muscular dissection of open approaches. For thoracolumbar spine fractures, percutaneous fixation allows for internal bracing of unstable fractures during healing while maintaining sagittal alignment. In instances of neurological compromise from fracture retropulsion, corpectomies may be required, and mini-open lateral approaches adopted from degenerative disease applications allow for a minimally invasive manner to treat the defect. These further allow for placement of wide rectangular-footprint expandable vertebral body replacement devices to provide anterior column support. We believe this allows for lower rates of subsidence and helps to maintain the biomechanical integrity necessary to prevent post-traumatic malalignment and kyphosis. Together, these minimally invasive techniques combined supply the spine surgeon with a minimally invasive armamentarium to treat nearly all thoracolumbar spine trauma. Surgeons should be comfortable with the strengths and shortcomings of these approaches in order to successfully apply them for this pathology.