At 1-year follow-up, they were still alive, able to walk www.selleckchem.com/products/3-deazaneplanocin-a-dznep.html without any external aids, and completely autonomous. 4. Discussion and Conclusions Major thoracic spine fractures are generally caused by high-energy trauma, and, for this reasons, they are frequently associated with rib fractures and pulmonary contusions with severe impairment of respiratory function. The primary goal in treating patients with thoracic lesions is the rapid improvement of respiratory function to avoid sequelae and potentially fatal pulmonary complications. To obtain this goal, it is mandatory to stabilize the spinal injuries as soon as possible and in the less invasive way. The decision to stabilize with long instead of short constructs in the present series of patients was determined either by the association of multiple thoracic spinal fractures or the necessity of stabilizing vertebral structures compromised by cancer.

When extensive instrumentation is required for proper support of thoracic vertebral lesions, there is necessarily a tradeoff between the desired mechanical efficacy and the debilitating procedures employed to obtain this efficacy. Until few years ago, it would have been unthinkable to use minimally invasive techniques to manage thoracic lesions because of the anatomical peculiarities of the region and the high risk of devastating complications [3]. With the advent of reliable percutaneous pedicle screw fixation systems, some surgeons recently tried to use this method in the treatment of thoracic fractures to minimize the invasiveness of an entirely open approach [4, 5].

Certainly the availability of the method relates to many aspects; the most important is the perfect visualization of the pedicle under fluoroscopy and its size and morphology. It is clear that the percutaneous approach allows consistent savings in terms of blood loss, recovery of the patient, and postoperative morbidity such as infection when compared to an open approach. Of course there are technical problems that need to be addressed, such as perfect visualization of the pedicle. Using fluoroscopically guided percutaneous insertion of thoracic pedicle screws, we relied more on AP views with the C-arm rotated in the sagittal plane according to the patient’s kyphosis than on lateral views, where the shoulders, in the upper thoracic spine, tend to reduce detection of the vertebral bodies and pedicles.

Perfect visualization of the pedicle, checked before starting Anacetrapib the procedure, is essential for the insertion of the screw. On the AP view the pedicle appears as an oval within the limits of the vertebral body. This was the landmark we used for percutaneous pedicle screw placement. To ensure satisfactory purchase in the pedicle, we introduced the tip of the screw slightly medially without exceeding the medial border of the oval to avoid spinal canal encroachment and far from the superior edge of the vertebral body to avoid penetration of the disc space.