Conflict of Interests The authors declare that they have no conflict of interests.
Surgical treatment of thoracic and lumbar spine fractures is based on different factors. Type of fracture, neurological deficit, general conditions, and associated injuries affect both treatment and final result. Although type B and C fractures following AO-Magerl classification [1] require surgical selleck Pacritinib treatment, most type A fractures without neurological involvement can be safely treated in a conservative way [2, 3]. Conservative treatment is a demanding procedure for the patient, and the risk of a final deformity has to be considered as a residual kyphosis can consistently worsen the quality of life of the patient. Moreover, some situations rule out the chance for a conservative treatment.

In case of polytrauma, claustrophobia, psychological disease, venous disease or previous deep venous thrombosis, obesity, and bronchopulmonary diseases, conservative treatment is not advisable. Attention must also be paid to the fact that younger and active workers refuse the conservative treatment in order to avoid bed rest and an inactive period. A traditional open surgery may be an overtreatment in all these cases, considering blood loss, possible complications, hospital stay, and delayed functional recovery. In this setting, a good option can be a percutaneous minimally invasive surgery (MIS) [4, 5]. This technique is suggested by the authors every time a conservative treatment is not indicated or advisable, and posterior open arthrodesis may represent an overtreatment. 2.

Materials and Methods From May 2005 to December 2011, 163 vertebral fractures of the thoracic and lumbar spine in 122 patients were stabilized. Eighty-tree patients were males and 39 females, the mean age was 48 years (from 15 to 85). Eighteen patients were polytrauma with an average Injury Severity Score of 25.2 (from 17 to 34). In those patient, percutaneous fixation was also intended to be a damage control procedure. The most frequent location was the thoracolumbar junction (T12-L1). All fractures were classified according to the AO-Magerlclassification: the vast majority were type A fractures (A1 and A3), while type B or type C were recorded in a few cases (Table 1). Table 1 Fractures distribution according to the type and level. The most frequent construct was the monosegmental one (one level above and one below the fractured vertebra) in 96 cases.

A multilevel construction was performed in 26 cases of multiple injuries. Overall, 553 pedicle screws were implanted with a percutaneous technique. AV-951 In 18 cases, a bone substitute (cement and hydroxyapatite) was introduced in the fractured vertebra to fill the anterior gap left after reduction, to better support the anterior column. In one of patients with poor bone stock due to osteoporosis, we used a fenestrated cemented screw, associated with kyphoplasty, to stabilize a T12 type A3 fracture (Figure 1).